Reimbursement Specialist (Hybrid), Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

13d•Hybrid

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.

Requirements

High School Diploma required, or some college preferred.
A minimum of 3 years’ experience within a healthcare environment can include insurance company, public health setting or an outsourcing company.
Must maintain a professional appearance and demeanor at all times.

Responsibilities

Demonstrate excellent patient service skills, assists in problem resolution both internal and external.
Demonstrate world class exceptional customer service and set example of correct phone etiquette.
Promote teamwork and a positive work environment.
Communicate to management when issues arise.
Demonstrate an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management.
Assist with training of new team members.
Independently problem solve and identify opportunities for improvement.
Complete tasks assigned in a timely and efficient manner in accordance with department policy.
Follow up on billed and/or denied accounts with third party payers.
Demonstrate ability to troubleshoot and escalate appropriate issues to management.
Raise awareness of payer related trends to management with supporting data.
Submit adjustment requests for services deemed uncollectable.
Verify Coordination of Benefits for all insurance provided.
Establish the payment status of billed or partially paid claims.
Determine the root cause of denial or partially paid claim.
Contact payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
Obtain payment or commitment from payer to pay.
Obtain status on billed, resubmitted, appealed and reconsideration claims.
Determine if claim is on file.
File appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
Request rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
Contact payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
Route denial to the appropriate team after denial has been determined that another department should resolve.
Route claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
Transfer unpaid balance to patient once patient responsibility has been determined.
Review Explanation of Benefits for clarity.
Process payer changes as needed.
Other duties as assigned.

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, (short-term disability buy-up available)
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