Network Reimbursement Specialist-Associate

Independent Health Association•Buffalo, NY

1d•$20 - $22

About The Position

The Network Reimbursement Specialist-Associate will ensure that all policies and processes that support physician, provider and ancillary agreements are adhered to and applied with a high degree of accuracy in workflows. The Network Reimbursement Specialist-Associate will have an understanding of industry and/or regulatory coding standards related to reimbursement methodology, billing practices, and coding rules and continue to build that knowledge while in this role. The primary responsibility of the Network Reimbursement Specialist-Associate will include independent determinations on manual claim procedures based on departmental standard operating procedures. They will also assist in the maintenance of additional supportive workflows on the team as directed by management. The Network Reimbursement Specialist-Associate will support claim processing via Network Reimbursement claim queues as directed. The incumbent will also be required to actively participate in work groups or teams to implement processes or provide information to management to assist in corporate objectives as they relate to professional reimbursement.

Requirements

High school diploma or GED required.
One (1) year of healthcare experience in claims, billing and/or reimbursement required.
Understanding of industry standard claims edits and correct coding requirements required.
Current certification of Certified Professional Coder, American Academy of Professional Coders or will be required to obtain certification within (1) one year required.
Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding systems.
Strong analytical skills.
Ability to assume responsibility and accomplish daily tasks with little to no direct oversight.
Effective written and verbal communication skills.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Associates degree preferred.

Responsibilities

Assist in the timely review and manual adjudication of professional claims through claim queues; meeting agreed upon key performance indicators for output with a high degree of accuracy.
Assist in the timely review of weekly, monthly, and/or quarterly claim reports to support network reimbursement workflows.
Understand Independent Health reimbursement policies and standard operating procedures and independently apply that to manual claim adjudication.
As directed, assist with the triage and maintenance of the professional fee request process.
Assist in updating the corporate Participating Provider Reimbursement Manual.
Assist in the maintenance of team meeting agendas and minutes as well as manage workflow volumes and turnaround times for the team.
As directed, actively contribute to or participate on team meetings and discussions as well as collaborate with other team members on assigned projects.
Assist in the establishment of standard operating procedures consistent with correct coding and billing guidelines or as defined by Independent Health policy.
As directed, assist Network Reimbursement Professionals and Management with matters of professional reimbursement or process implementation.
Assist in the tracking and maintenance of reimbursement policies.
Establish process to continue to grow knowledge of industry standards related to reimbursement methodologies, billing practices and coding rules.