Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare • Gaithersburg, MD

107d • $20 - $27

About The Position

Adventist HealthCare seeks to hire an experienced Reimbursement Specialist for our Patient Financial Services department who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing. As a Reimbursement Specialist, you will establish the payment status of billed or partially paid claims, determine the root cause of a denial or partially paid claim, and contact the payer to determine if additional information is needed to adjudicate the claim. You will also obtain payment or commitment from the payer, obtain status on billed, resubmitted, appealed and reconsideration claims, and determine if the claim is on file. Additionally, you will file appeals, request rebills or corrections, and route claims to the appropriate team as necessary. This role requires frequent communication with payers and a thorough review of claims and denials.

Requirements

• High School Diploma required, or some college preferred.
• A minimum of 3 years’ experience within a healthcare environment.
• Ability to work under frequent pressure due to time constraints.
• Frequent use of a PC involving focused concentration.
• Ability to perform frequent walking, standing, bending, kneeling/crouching, sitting, etc.
• Light physical effort (lifts or carries up to 10lbs).
• Professional appearance and demeanor at all times.

Responsibilities

• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of a denial or partially paid claim.
• Contacts the payer to determine if additional information is needed to adjudicate the claim.
• Obtains payment or commitment from the payer to pay.
• Obtains status on billed, resubmitted, appealed and reconsideration claims.
• Determines if the claim is on file.
• Files appeal after review of a denial indicates an appeal is needed.
• Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Routes the denial to the appropriate team after it has been determined that another department should resolve.
• Routes claim to the biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers the unpaid balance to the patient once patient responsibility has been determined.
• Reviews the Explanation of Benefits for clarity.
• Processes payer changes as needed.

Benefits

• Work life balance through nonrotating shifts.
• Recognition and rewards for professional expertise.
• Free Employee parking.
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire.
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D.
• Paid Time Off.
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period.
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance.
• Subsidized childcare at participating childcare centers.
• Tuition Reimbursement.
• Employee Assistance Program (EAP) support.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED