Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

2d•$21 - $29•Hybrid

About The Position

Adventist HealthCare is seeking an experienced Reimbursement Specialist for its Patient Financial Services Department. The role supports patient financial services by following up with third-party payers on billed, denied, resubmitted, appealed, and reconsideration claims; determining claim and payment status and the causes of denials or partial payments; and pursuing payment or appropriate claim resolution. The specialist contacts payers by phone or through online portals, reviews explanations of benefits, verifies coordination of benefits, processes payer changes, and transfers balances to patients once responsibility is established. The role also supports customer service, teamwork, problem-solving, process improvement, communication with management, and training new team members. This is a full-time, 40-hour-per-week position with a typical schedule of 8 a.m. to 5 p.m., Monday through Friday. It is a day-shift hybrid role, and holiday requirements follow the company holiday calendar. The position is classified as non-exempt under the Fair Labor Standards Act. The listed pay range is $20.97–$28.97.

Requirements

High school diploma required.
At least 3 years of experience in a healthcare environment, which may include an insurance company, public health setting, or outsourcing company.

Nice To Haves

Some college preferred.

Responsibilities

Provide excellent patient service and resolve issues for internal and external customers.
Demonstrate exceptional customer service and appropriate phone etiquette.
Promote teamwork and a positive work environment.
Communicate issues to management and determine when to troubleshoot independently or escalate.
Assist with training new team members.
Solve problems independently and identify opportunities for improvement.
Complete assigned tasks efficiently and on time in accordance with department policy.
Follow up with third-party payers on billed, denied, resubmitted, appealed, and reconsideration claims.
Identify payer-related trends and share them with management using 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 and determine the root cause of denials or partial payments.
Contact payers by phone or online portal to determine whether additional information is needed to adjudicate a claim, and obtain payment or a commitment to pay.
Determine whether a claim is on file.
File appeals when a denial review indicates an appeal is needed or the payer agrees to reprocess the claim.
Request rebills or corrections when a denial review determines they are needed.
Route denials to the appropriate team when another department should resolve them.
Route claims to a biller only when no claim is on file after reviewing the bill scrubber acceptance report.
Transfer unpaid balances to patients once patient responsibility has been determined.
Review explanations of benefits for clarity.
Process payer changes as needed.
Perform 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 eligible dependents effective on the date of hire.
Employer-paid short- and long-term disability, basic life insurance, and AD&D; short-term disability buy-up is available.
Paid time off.
Employer retirement contribution and match after one year of eligible employment, with a three-year vesting period.
Voluntary benefits, including flexible spending accounts, legal plans, and life, pet, auto, home, long-term care, and critical illness and accident insurance.
Subsidized childcare at participating childcare centers.
Tuition reimbursement.
Employee Assistance Program support.