Reimbursement Specialist Contract Compliance

Intermountain Health

1d • $24 - $37

About The Position

The Reimbursement Specialist is responsible for performing a variety of complex duties, including working insurance claims follow–up and escalations, interpreting contract language, and tracking trends. This specialist works facility claims ("Hospital billing") and maintains inventory (work queue lists) at acceptable aging levels by prompt review and follow up of claims. Performs all duties in a manner which promotes teamwork and reflects Intermountain mission, vision and values. Looking for candidates with: Knowledge in reading explanation of benefits, understanding ANSI codes/denial codes Ability to identify trends in underpayments/overpayments Ability to interpret payer contracts for validation of correct reimbursement on Hospital inpatient/outpatient claims Knowledge of all Commercial and Government payers Experience in using Excel, creating pivot tables Epic training is a plus! Essential Functions Responsible for the accurate and timely submission of reconsiderations and disputes. Responsible for maintaining work queues at acceptable ageing, by updating accounts and tracking trends. Research and resolve a variety of issues relating to payment discrepancies. Identify issues and/or trends and communicate findings to management, including payer, system or registration issues. Maintain basic understanding and knowledge of health insurance plans, policies and procedures. Accurately and thoroughly document findings and actions taken while meeting/exceeding productivity and quality standards Participate and attend meetings and training to develop job knowledge and communicate with other caregivers. Skills Microsoft Office Computer literacy HIPAA regulations Communication (oral and written) Accountability/ability to work independently Contract Interpretation Customer Service Read and interpret EOB’s (Explanation of Benefits). Knowledge of medical billing and collections Medical terminology - Participate and lead special projects, as assigned. Oversee work flow implementation with internal and external partners. Compile and coordinate materials and feedback on special projects. Trains and mentors new associates to the department. Serves as a subject matter expert and resource to answer questions within the department. Minimum Qualifications - High School Diploma or equivalent, required -Must obtain CSPR or CRCR credentials with 1 yrs of hire date ( provided through employer) Minimum of three (3) years of experience in revenue cycle insurance follow up or denial management, required- Extensive knowledge of managed care contract interpretation, required - Associate's Degree, preferred - At least three (3) years of work experience in a complex invoice/billing/reconciliation environment, preferred Knowledge of revenue and ICD 10 coding practices "Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings." We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington. Physical Requirements Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set-up and use. Expected to lift and utilize full range of movement to transport, pull, and push equipment. Will also work on hands and knees and bend to set-up, troubleshoot, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items. For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. Thanks for your interest in continuing your career with our team!

Requirements

• High School Diploma or equivalent, required
• Must obtain CSPR or CRCR credentials with 1 yrs of hire date ( provided through employer)
• Minimum of three (3) years of experience in revenue cycle insurance follow up or denial management, required
• Extensive knowledge of managed care contract interpretation, required
• Microsoft Office
• Computer literacy
• HIPAA regulations
• Communication (oral and written)
• Accountability/ability to work independently
• Contract Interpretation
• Customer Service
• Read and interpret EOB’s (Explanation of Benefits).
• Knowledge of medical billing and collections
• Medical terminology

Nice To Haves

• Associate's Degree, preferred
• At least three (3) years of work experience in a complex invoice/billing/reconciliation environment, preferred
• Knowledge of revenue and ICD 10 coding practices
• Epic training is a plus!

Responsibilities

• Responsible for the accurate and timely submission of reconsiderations and disputes.
• Responsible for maintaining work queues at acceptable ageing, by updating accounts and tracking trends.
• Research and resolve a variety of issues relating to payment discrepancies.
• Identify issues and/or trends and communicate findings to management, including payer, system or registration issues.
• Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
• Accurately and thoroughly document findings and actions taken while meeting/exceeding productivity and quality standards
• Participate and attend meetings and training to develop job knowledge and communicate with other caregivers.
• Participate and lead special projects, as assigned.
• Oversee work flow implementation with internal and external partners.
• Compile and coordinate materials and feedback on special projects.
• Trains and mentors new associates to the department.
• Serves as a subject matter expert and resource to answer questions within the department.

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
• Learn more about our comprehensive benefits package here.
• Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment.
• Learn more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees