Summary:
The Reimbursement Specialist is responsible for assisting the Reimbursement Supervisor and fellow staff in following up with commercial and governmental payers to ensure timely resolution of billing issues and accurate claims reimbursement. This individual is also responsible for collaborating with other departments to drive payer collections, communicating process issues and improvements to the supervisor and training new staff.
Job Duties & Responsibilities :
Identifies and analyzes underpayments to determine the reasons for discrepancies and processes denials and appeals; examines claims to ensure payers are complying with contractual agreements.
Reviews posted payments to ensure accuracy; analyzes explanation of benefits to ensure proper reimbursement.
Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquires and concerns, and works to develop and maintain positive relationships with payers.
Monitors and reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle if necessary to resolve issues.
Analyzes data to track collection efforts, identify trends, and provide team with updates and ideas for improvement.
Monitors payer files for accuracy, ensures payer documentation is completed by follow up staff, and assists in updating files with pertinent information as necessary.
Assists other follow up staff in identifying high-risk accounts and prioritizing follow up efforts.
Helps to work and resolve accounts from other staff members workloads to prevent backlogs and fills in as needed for absent staff.
Maintains superior understanding of claims management, third party payer guidelines, state and federal regulations, and all other functions of the job; educates and trains other follow-up staff as needed.
Collaborates with other departments to identify best-practice collections strategies, align goals, and improve collections.
Maintains compliance with HIPAA guidelines and ensures staff maintain discrepancy when handling patient information
Promote a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.
Be open to change and actively support change.
Be open to others’ ideas and points of view.
Evaluate employees objectively and provide employees with periodic feedback.
Promote department goals as well as the mission of the hospital.
Communicate goals to fellow staff members.
Maintain department policies and procedures.
Include requirements and guidelines from external agencies (i.e., Joint Commission , State of Wisconsin).
Maintain and/or communicate to appropriate party function backlog at a set time.
Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.
Demonstrate acceptance and training of student interns in the department, as directed.
Participate in hospital committees, performance improvement team meetings, and team projects, as directed.
Demonstrate punctuality and preparedness.
Demonstrate effective communication skills.
Demonstrate good organizational skills.
Contribute in a positive, solution-focused manner.
Conduct self in a professional manner.
Demonstrate organizational skills that promote timely response to all inquiries and to task completion.
Communicate with all individuals in a positive and professional manner.
Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution.
Communicate concerns and provide solutions for same.
Project a professional image by wearing appropriate, professional attire.
Ability to influence departments within Rogers and provide technical guidance.
Additional Job Description:
Physical/Mental Demands :
This role primarily involves sedentary work, requiring the employee to sit for extended periods. Occasional walking, standing, or reaching may be…