Reimbursement Program Specialist
About The Position
Shield HealthCare is looking for a Reimbursement Program Specialist in Valencia, CA responsible for implementing internal processes and controls that ensure compliance with new and existing regulatory requirements for the distribution of durable and disposable medical equipment and supplies. The Reimbursement Programs Specialist ensures the organization is paid correctly, reduces claim denials, and helps patients access needed medical supplies. This role requires accurate and current knowledge of medical reimbursement rules, insurance policy changes, and various medical compliance regulations. This position is on-site in Valencia, CA.
Requirements
- 3+ years working in a Reimbursement Programs position with knowledge of medical billing/coding and insurance reimbursement processes
- Bachelor’s degree in healthcare administration, public health, business, organizational management, or equivalent experience in healthcare compliance
- Proficiency in Microsoft 365 (Excel, PowerPoint, Word, SharePoint, Teams)
- A thorough understanding of HIPAA regulations, requirements, and guidelines, familiar with the privacy and security rules and how they apply to healthcare
- Ability to read, analyze, and interpret technical journals, legal documents, medical terminology, and complex documents
- Skilled in fostering collaborative relationships across internal teams and with external partners
- Excellent written and verbal communication skills
- Strong organizational skills, with extreme attention to details, the ability to manage multiple priorities, projects, respond to changing business needs, and meet critical deadlines
- Strong analytical and problem-solving skills
Responsibilities
- Partners with healthcare providers, government and advocacy agencies assigned to ensure proper program coverage and compliance
- Effectively maintains and communicates current company policies, procedures, and practices to ensure all departments have accurate, relevant information related to reimbursement programs
- Monitors regulatory agency policy changes to include research and communication of findings to internal stakeholders
- Assists in managing reimbursement related issues and policies/procedures, communicating trends and suggesting corrective actions to leadership
- Acts as a resource to the organization for payer knowledge and support
- Partners with internal departments to ensure customer orders are shipped and billed without reimbursement issues
- May act as a liaison between insurance companies, healthcare providers, and customers
- Additional projects supporting the reimbursement programs as assigned by the department leader
Benefits
- Medical, Dental, and Vision
- 401(k) with Company Match
- Sick and Vacation Days
- Flexible Spending Account
- Life & Disability Insurance
- Education Assistance
- Employee Referral Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
