Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

11h•Onsite

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. The Reimbursement Specialist will demonstrate excellent patient service skills, assist in problem resolution both internal and external, and promote teamwork and a positive work environment. This role involves independently problem-solving, identifying opportunities for improvement, and completing tasks in a timely and efficient manner in accordance with department policy. The specialist will follow up on billed and/or denied accounts with third party payers, verify Coordination of Benefits, and determine the root cause of denial or partially paid claims. They will contact payers to obtain payment or commitment to pay, file appeals, request rebills/corrections, and route denials or claims to the appropriate teams. The role also includes transferring unpaid balances to patients and reviewing Explanation of Benefits.

Requirements

High School Diploma required
A minimum of 3 years’ experience within a healthcare environment can include insurance company, public health setting or an outsourcing company.

Nice To Haves

some college preferred

Responsibilities

Demonstrates excellent patient service skills, assists in problem resolution both internal and external.
Demonstrates world class exceptional customer service and set example of correct phone etiquette.
Promote teamwork and a positive work environment.
Communicates to management when issues arise.
Demonstrates an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management.
Assist with training of new team members.
Independently problem solves and identifies opportunities for improvement.
Completes tasks assigned in a timely and efficient manner in accordance with department policy.
Follows up on billed and/or denied accounts with third party payers.
Demonstrates ability to troubleshoot and escalate appropriate issues to management.
Raises awareness of payer related trends to management with supporting data.
Submits adjustment requests for services deemed uncollectable.
Verifies Coordination of Benefits for all insurance provided.
Establishes the payment status of billed or partially paid claims.
Determines the root cause of denial or partially paid claim.
Contacts 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.
Obtains status on billed, resubmitted, appealed and reconsideration claims.
Determines if claim is on file.
Files appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
Contacts payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
Routes denial to the appropriate team after denial has been determined that another department should resolve.
Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
Transfers unpaid balance to patient once patient responsibility has been determined.
Reviews Explanation of Benefits for clarity.
Processes 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