Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

33d•$21 - $27

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. As a Reimbursement Specialist, you will: Establishes the payment status of billed or partially paid claims. Determines the root cause of a denial or partially paid claim. Contact the payer either by phone call or the online payer portal to determine if the payer is requesting additional information in order to adjudicate the claim. Obtain payment or commitment from the payer to pay. Obtains status on billed, resubmitted, appealed, and reconsideration claims. Determines if the claim is on file. Files an appeal after review of a denial indicates an appeal is needed, or the payer agrees to reprocess the claim. Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed. Contact the payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication. Routes the denial to the appropriate team after denial has been determined that another department should resolve. Routes claim to the biller only when no claim is on file after review of the bill scrubber acceptance report. Transfers the unpaid balance to the patient once patient responsibility has been determined. Review the Explanation of Benefits for clarity. Processes payer changes as needed.

Requirements

High School Diploma required, or some college preferred.
A minimum of 3 years’ experience within a healthcare environment can include an insurance company, public health setting, or an outsourcing company.
Frequent pressure due to time constraints
Frequently works at a PC involving focused concentration.
Frequent walking, standing, bending, kneeling/crouching, sitting, etc.
Light physical effort (lifts or carries up to 10lbs)
Atmosphere and environment associated with an office setting.
Must maintain a professional appearance and demeanor at all times.

Responsibilities

Establishes the payment status of billed or partially paid claims.
Determines the root cause of a denial or partially paid claim.
Contact the payer either by phone call or the online payer portal to determine if the payer is requesting additional information in order to adjudicate the claim.
Obtain payment or commitment from the payer to pay.
Obtains status on billed, resubmitted, appealed, and reconsideration claims.
Determines if the claim is on file.
Files an appeal after review of a denial indicates an appeal is needed, or the payer agrees to reprocess the claim.
Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
Contact the payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
Routes the denial to the appropriate team after denial has been determined that another department should resolve.
Routes claim to the biller only when no claim is on file after review of the bill scrubber acceptance report.
Transfers the unpaid balance to the patient once patient responsibility has been determined.
Review the Explanation of Benefits for clarity.
Processes payer changes as needed.

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