Reimbursement Team Lead, Day Shift, Patient Financial Services

Adventist HealthCare•Gaithersburg, MD

2d•$22 - $30

About The Position

Adventist HealthCare seeks to hire an experienced Reimbursement Team Lead 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 Team Lead, you will: Coordinate and monitor billing claims electronically as well as hardcopy. Submit adjusted claims due to audits, changes to charges, diagnosis, billing codes, and DRG. Understand and review bills both UB04 and/or 1500 forms to third-party payers daily. Supports the denials prevention effort to collaborate on ways to prevent denials due to billing concerns or challenges. Communicate and coordinate with Clinical Coders when issues arise due to coding edits. Ensure filing of all secondary and tertiary claims after primary claims have been paid. Work on all assigned claims daily by resolving edits, payer rejections, validating claim errors, and forwarding claims to other departments as needed. Handles all customer calls, both internal and external in a professional and courteous manner Steps into billing work queues and associated tasks to review, analyze, and provide corrective action. Works in EHR system to troubleshoot and escalate any barriers or concerns to the manager in a timely and clearly articulated, and documented format Work with the team to keep workqueues at agreed-upon levels to keep on task with department goals and objectives. Report updates and findings to Billing Supervisor and PFS leadership as needed

Requirements

Good organizational, written, and verbal communication skills
Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
Ability to work as an independent contributor.
Proficiency in Microsoft Office, including Outlook, Word, and Excel.
Strong attention to details and accuracy, using problem-solving skills
At least 2-4 years of experience in billing expertise in an acute care setting
High School Diploma required; some college preferred.

Nice To Haves

Fluency in Cerner and/or claims scrubber activities is desirable.
Familiarity with Cash Posting functions and duties in an Acute Hospital setting preferred

Responsibilities

Coordinate and monitor billing claims electronically as well as hardcopy.
Submit adjusted claims due to audits, changes to charges, diagnosis, billing codes, and DRG.
Understand and review bills both UB04 and/or 1500 forms to third-party payers daily.
Supports the denials prevention effort to collaborate on ways to prevent denials due to billing concerns or challenges.
Communicate and coordinate with Clinical Coders when issues arise due to coding edits.
Ensure filing of all secondary and tertiary claims after primary claims have been paid.
Work on all assigned claims daily by resolving edits, payer rejections, validating claim errors, and forwarding claims to other departments as needed.
Handles all customer calls, both internal and external in a professional and courteous manner
Steps into billing work queues and associated tasks to review, analyze, and provide corrective action.
Works in EHR system to troubleshoot and escalate any barriers or concerns to the manager in a timely and clearly articulated, and documented format
Work with the team to keep workqueues at agreed-upon levels to keep on task with department goals and objectives.
Report updates and findings to Billing Supervisor and PFS leadership 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