Reimbursement Specialist II

St. Jude Children's Research Hospital•Memphis, TN

4d•$24 - $42•Hybrid

About The Position

Every day here at St. Jude is a little different, with a mix of tasks. Behind each one is a real patient, so the work you do makes a big impact. We’re looking for a thoughtful, detail-oriented Reimbursement Specialist II who feels comfortable in a busy hospital or medical office environment and can keep up with a high volume of work without losing accuracy or customer and patient focus. This job is a great fit for someone who understands healthcare billing—things like claims, EOBs, insurance details, patient responsibility, CPT codes—and can confidently connect the dots when questions come up. Experience with systems like EPIC or similar, and Workday is helpful, but not required. In this role, you’ll spend your day working in the Outpatient Services/Programs (OPS) database, handling invoices, coordinating outside referrals from Epic, reviewing submitted bills, and staying on top of emails and follow-ups. It’s not a repetitive, “same thing every day” kind of job—there’s a lot of research and problem-solving involved, so strong critical-thinking skills really matter. You’ll be communicating regularly with a variety of people, including clinical staff, patients and family members, insurance representatives, and vendors, so being clear, professional, and approachable goes a long way. And while the work is independent, you’ll be part of a supportive team that truly works well together and is always there to help! Overall, this is an excellent opportunity for someone who enjoys figuring things out, taking ownership of their work, and being part of a team that has each other’s backs. The Reimbursement Specialist II is responsible for assisting with the coordination of Affiliate Program (AP). Main tasks include: Payment activities, timely processing of invoices, outside professional services and contractual terms, and timely entry of payments/refunds into the centralized database. -Maintains a current listing of approved providers, contact information, and discounting agreements. -Interprets existing provider contracts and agreements when approving invoices for review. -Assures invoices meet hospital requirements, medical care guidelines, and/or Office of Inspector General (OIG) ruling expectations and follows-up as needed. -Maintains a working relationship with clients conducive to the nurturing of new/renewal contracts with clients. -Assists in the maintenance and enhancement of various databases to meet unique/specific financial, clinical, and administrative needs. -Ensures that patients and their guardians are assisted with any questions or problems in a timely manner.

Requirements

High school diploma/GED required.
Minimum Requirement: 2+ years of experience (in an academic or research setting, preferred).
Some experience in healthcare office environment with some understanding of managed care contract and reimbursement models.
Seeks to understand customer needs by asking clarifying questions.
Prioritizes responses to customer queries.
Solves routine customer problems as per processes, and seeks guidance, if needed for quick resolution.
Shows general awareness of relevant regulatory requirements related to own work.
Understands and supports standard process requirements for compliance within own area.
Shows some understanding of relevant compliance regulations and it's importance in own area within finance.
Questions, clarifies, and provides explanations as needed.
Checks documents and reports for clarity and accuracy.
Seeks and provides information within and outside team in a timely manner.
Addresses problems in a structured, logical approach.
Asks for guidance and tries out new ideas when changes in approach are required.
Adapts quickly and positively; learns from mistakes.
Plans around multiple tasks and priorities well within own work.
Is able to cope with unexpected changes in routine and delivers planned outcomes on time.
Escalates issues/problems and seeks support in a timely manner.
Exhibits basic understanding of managed care processes and managed care contracting requirements & tools.
Performs standard tasks within own area (e.g., documentation, contributing to reports), under supervision.
Has basic understanding of medical software systems, tools and processes.
Performs standard tasks (e.g., of data recording and reporting on medical record data management systems), under supervision.

Nice To Haves

Experience with systems like EPIC or similar, and Workday is helpful, but not required.
Experience in an academic or research setting is preferred.

Responsibilities

Execute assigned tasks related to managed care (e.g., provider enrollment and credentialing, claims, payor issues) within own area of responsibility, with limited guidance; address standard requests and queries for timely resolution.
Coordinate with internal teams to collect information and create relevant documentation (e.g., enrollment and credentialing, claims) & standard reports.
Provide assistance for resolution of any denials related to contractual, enrollment or credentialing issues in a timely manner.
Perform other duties as assigned to meet the goals and objectives of the department and institution.
Maintains regular and predictable attendance.
Payment activities, timely processing of invoices, outside professional services and contractual terms, and timely entry of payments/refunds into the centralized database.
Maintains a current listing of approved providers, contact information, and discounting agreements.
Interprets existing provider contracts and agreements when approving invoices for review.
Assures invoices meet hospital requirements, medical care guidelines, and/or Office of Inspector General (OIG) ruling expectations and follows-up as needed.
Maintains a working relationship with clients conducive to the nurturing of new/renewal contracts with clients.
Assists in the maintenance and enhancement of various databases to meet unique/specific financial, clinical, and administrative needs.
Ensures that patients and their guardians are assisted with any questions or problems in a timely manner.