Reimbursement Specialist

VGM Group•Waterloo, IA

3d•Hybrid

About The Position

HOMELINK, a business unit within VGM Group’s family of businesses, is an innovative national provider of integrated specialty services for the healthcare and workers’ compensation industries. HOMELINK provides a comprehensive offering of ancillary care products and services, including advanced clinical programs, and partners with both payers and providers. As a privately held, employee-owned company, HOMELINK team members are committed to delivering high quality service from referral to resolution. The Reimbursement Specialist is a subject matter expert for workers’ compensation and CMS Medicare fee schedules and bill review. The Reimbursement Specialist is responsible for determining appropriateness of charges, enforcing bill review edits, and maintaining up-to-date knowledge of federal and state fee schedules, rules, and regulations. All HOMELINK team members will be expected to follow strict confidentiality and HIPAA privacy and security guidelines.

Requirements

Minimum 5 years workers’ compensation and/or group health bill review experience
Must comply with continuing education per Company, regulatory, contractual, and accreditation requirements.
Knowledge of healthcare industry billing and/or coding terminologies such as ICD-10, HCPCS, CPT, and modifiers.
Exemplary relationship management skills to communicate effectively with employees, management, and insurance companies
Ability to routinely adapt to change while working in a fast paced, complex environment
Team player with excellent communication skills
Strong time management and organization skills
Strong analytical and problem-solving skills
Operation of office equipment and using technology efficiently such as computers, phones, misc. office equipment
Visual abilities to include reading, distance vision and peripheral vision
Moving throughout the VGM facilities when needed.

Nice To Haves

Revenue Cycle Management Specialist and/or Certified Professional Coder certifications preferred

Responsibilities

Analyze, interpret, and maintain relevant knowledge of federal, state, workers' compensation, commercial, and third-party pricing
Research all required sources of documentation for federal and state fee schedules, including current data and fee schedule information
Educate operations and technical teams and update documentation pertaining to regulatory changes
Educate leadership, sales, and account management teams about major pricing changes to Medicare and workers' compensation fee schedules.
Ensure that billing practices adhere to payer regulations and industry standards
Provide expertise on which bills to formally dispute with bill review companies.
Assist with audit readiness and payer audits.
Use CPT, HCPCS and ICD-10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rationale
Represent HOMELINK on external client-facing calls as a subject matter expert in the above areas
Other duties as assigned