Reimbursement Specialist

Rogers Behavioral Health•Oconomowoc, WI

About The Position

The Reimbursement Specialist assists the Reimbursement Supervisor and fellow staff with follow-up to commercial and governmental payers to resolve billing issues promptly and ensure accurate claims reimbursement. The role collaborates with other departments to advance payer collections, communicates process issues and improvement opportunities to the supervisor, and trains new staff. It also supports the management of high-risk accounts, monitors payer documentation and files, helps prevent work backlogs, and maintains knowledge of claims management, payer guidelines, regulations, and revenue-cycle functions. The position promotes a respectful, collaborative, and solution-focused team environment; supports department and hospital goals; maintains department policies and procedures and applicable external requirements; and contributes to committees, performance-improvement activities, and team projects as directed. The role requires professional communication, organization, punctuality, and the ability to provide technical guidance and influence departments. The work is primarily sedentary, with occasional walking, standing, and reaching. The employee must be able to lift at least 20 pounds and use manual dexterity to operate office equipment. Verbal, hearing, numerical, reading, and written communication abilities are required. A post-employment physical exam by a licensed physician is required to verify the ability to perform the job duties.

Requirements

High school diploma or equivalent required.
At least three years of relevant experience in mental health or medical insurance billing and/or collections required.
At least three years of experience in Patient Financial Services encompassing all levels of care and UB04 and HCFA 1500 claims billing required.
Demonstrated knowledge of and experience with third-party payer guidelines, reimbursement, follow-up, and collections.
Demonstrated knowledge of claims review and analysis, ICD-10, CPT, and HCPCS coding, and medical terminology.
Effective communication, leadership, organizational, and problem-solving skills.
Ability to manage multiple tasks and projects simultaneously.
Ability to analyze data, identify improvement opportunities, and implement change.
Strong interpersonal and customer service skills.
Proficiency with Microsoft Word, Excel, Outlook, Teams, OneNote, and Oracle Health Patient Accounting systems.
Ability to work quickly and effectively in a fast-paced, detail-oriented environment while meeting deadlines.
Ability to lift a minimum of 20 pounds and perform the physical and communication demands described for the role.
Ability to perform job duties as verified by a post-employment physical exam by a licensed physician.

Nice To Haves

Associate or bachelor’s degree preferred.

Responsibilities

Identify and analyze underpayments, determine reasons for discrepancies, process denials and appeals, and examine claims for payer compliance with contractual agreements.
Review posted payments and explanations of benefits for accuracy and proper reimbursement.
Contact payers about outstanding claims, payment variances, inquiries, and concerns, while developing and maintaining positive payer relationships.
Monitor denial reason codes and underpayments to identify root causes, coordinating with payer contracting and other revenue-cycle areas to resolve issues when needed.
Analyze collection data, track efforts, identify trends, and provide the team with updates and improvement ideas.
Monitor payer files for accuracy, ensure follow-up staff complete payer documentation, and update files with relevant information as needed.
Help follow-up staff identify high-risk accounts and prioritize follow-up efforts.
Work and resolve accounts in other staff members’ workloads to prevent backlogs and provide coverage for absent staff.
Maintain knowledge of claims management, third-party payer guidelines, state and federal regulations, and job functions; educate and train follow-up staff as needed.
Collaborate with other departments to identify effective collection strategies, align goals, and improve collections.
Maintain compliance with HIPAA guidelines and ensure staff maintain discretion when handling patient information.
Promote a respectful team environment, support change and differing viewpoints, and provide objective employee feedback and periodic evaluations.
Promote department and hospital goals and mission, communicate goals to staff, and maintain department policies and procedures, including applicable external-agency requirements.
Maintain or communicate functional backlog information to the appropriate party at a set time.
Educate new staff on relevant regulations and requirements as directed, and accept and train student interns as directed.
Participate in hospital committees, performance-improvement team meetings, and team projects as directed.
Demonstrate punctuality, preparedness, effective communication, organization, professionalism, and timely response to inquiries and task completion.
Address peer concerns calmly and constructively, communicate concerns with proposed solutions, and project a professional image through appropriate attire.
Influence departments within Rogers and provide technical guidance.