Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

1d•Hybrid

About The Position

Adventist HealthCare is seeking an experienced Reimbursement Specialist for its Patient Financial Services Department. The role supports the organization’s mission to extend God’s care through physical, mental, and spiritual healing. The specialist follows up on billed and denied accounts with third-party payers, determines claim payment status and denial causes, pursues payment or payer commitments, and coordinates claim corrections, appeals, and routing. The position also emphasizes excellent patient and customer service, teamwork, timely completion of work, communication with management, problem-solving, and assisting with new team member training. This is a full-time, 40-hour-per-week day-shift position with a hybrid schedule. The typical schedule is 8 a.m. to 5 p.m., Monday through Friday, following the company holiday calendar. The listed pay range is $20.97–$28.97. The position is classified as non-exempt under the FLSA.

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 and customer service and help resolve issues for internal and external customers.
Model appropriate phone etiquette and promote teamwork and a positive work environment.
Communicate issues to management and determine when to troubleshoot independently versus escalate.
Assist with training new team members.
Independently troubleshoot problems and identify opportunities for improvement.
Complete assigned tasks promptly and efficiently in accordance with department policy.
Follow up on billed and denied accounts with third-party payers.
Identify payer-related trends and share them with management, supported by data.
Submit adjustment requests for services deemed uncollectable.
Verify coordination of benefits for all insurance provided.
Establish payment status for billed or partially paid claims and determine the root cause of denials or partial payments.
Contact payers by phone or through online portals to determine whether additional information is needed to adjudicate claims.
Obtain payment or a commitment from the payer to pay.
Obtain status updates for billed, resubmitted, appealed, and reconsideration claims, and determine whether a claim is on file.
File appeals when review indicates one is needed or the payer agrees to reprocess the claim.
Request rebills or corrections when review determines they are needed.
Route denials to the appropriate team when another department should resolve them.
Route a claim to the biller only when no claim is on file after reviewing the bill scrubber acceptance report.
Transfer unpaid balances to patients once patient responsibility is 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 date of hire
Employer-paid short- and long-term disability
Basic life insurance and AD&D
Short-term disability buy-up available
Paid time off
Employer retirement contribution and matching after one year of eligible employment, with a three-year vesting period
Voluntary flexible spending accounts
Voluntary legal plans
Voluntary 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