Reimbursement Specialist II

Sarasota Memorial Health Care System • Sarasota, FL

15d

About The Position

Provides administrative support for accurate and timely posting of Surgery, Emergency Room (ECC), hospital-wide observation, or Delivery/High Risk Antepartum/Testing/Triage charges for SMHCS or North Port, under the direction and supervision of Revenue Cycle Management. Ensures compliant charging practices for all payors by reviewing medical records to confirm that clinical documentation supports the accuracy of charges. Independently resolves Correct Coding Initiative (CCI) edits for the applicable charges and performs other reimbursement assignments to address billing, coding, or collection issues. Interacts with clinical staff to educate them and improve documentation supporting the care provided and charges posted. Assists Revenue Cycle staff with information for appeals or audits. Acts as a leader, mentor, and trainer to other Reimbursement Specialists.

Requirements

• Minimum of four years of health care experience involving charging practices and patient flow processes.
• Coding certification.
• High school diploma, GED, or certificate.

Nice To Haves

• Clinical certification from a recognized health care credentialing organization in a specialty area, such as RRA, RT, VI, CI, RCIS, RVS, SCFA, or CST.
• Demonstrated interpersonal and communication skills.
• Working knowledge of commonly used computer applications.
• Ability to work with minimal supervision.
• Proficiency with medical terminology.
• Proficiency with charging and coding as applied to departments such as Surgery, Emergency Room, Observation, or Delivery/High Risk Antepartum/Testing/Triage.

Responsibilities

• Post applicable Surgery, Emergency Room (ECC), observation, or Delivery/High Risk Antepartum/Testing/Triage charges accurately and on time.
• Review medical records to ensure clinical documentation supports charges and compliant charging practices for all payors.
• Independently resolve applicable Correct Coding Initiative (CCI) edits.
• Perform reimbursement assignments to resolve billing, coding, or collection issues.
• Educate clinical staff and help improve clinical documentation supporting the care provided and charges posted.
• Provide Revenue Cycle staff with information to support appeals or audits.
• Act as a leader, mentor, and trainer to other Reimbursement Specialists.

What This Job Offers

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