Reimbursement Specialist - Columbia, United States - Genesis Health Care, Inc.

Description

Title:
Reimbursement Specialist


Reports to:
Executive Financial Officer


Updated on: 05/08/2024


Status:
Non-Exempt


Approved by:

HR
***Primary responsibilities include ensuring all payments, adjustments and denials received from insurance companies are posted to patient accounts timely and accurately. Ensure rejections and denials are reprocessed in a timely manner to ensure payments from the insurance companies. Communicate with patients and/or insurance companies in a friendly professional manner.


PRIMARY ACCOUNTABILITIES

• Achieve Results_
• Correct and refile all rejected and denied claims efficiently and timely.
• Upload missing documentation requests timely.
• Monitor reimbursement from payers to ensure payment agrees with upon fee schedule(s).
• 4. Prepare and deliver all reports as directed.
• Operational Excellence_
• Ensure and uphold the confidentially requirements of all patient records and manage all daily tasks and activities consistent with HIPAA, state and federal laws and regulations, as well as the clinic's policies and regulations regarding confidentiality and security.
• Assures that all payments issued are appropriate and documented as ordered and received.
• Relationships_
• Develop and ensure effective, positive relationships within and among the clinic staff, as well as with patients, vendors, contractors, and related resources.
• Professionalism_
• Ensure all actions, job performance, personal conduct and communications always represent the organization in a highly professional manner.
• Uphold and ensure compliance with and attention to all corporate policies and procedures, as well as the mission and values of the organization.

PRIMARY TASKS & DUTIES

• Work returned claims from Third Party Company timely and accurately.
• Monitor and work assigned claims in a HOLD Status.
• Research and process appeals when appropriate and make recommendations.
• Update patient information to ensure claims process correctly.
• Review patient accounts for billing errors.
• Assist patients will billing questions.
• Adjust patient accounts according to the Sliding Fee Scale guidelines.
• Discuss payment options with patients to include payment plans, pay-it-forward (PIF), or compromise.
• Research overpayments and if appropriate request, post refunds.
• Respond to inquiries from outside agencies and insurance companies to assist in claim payment processing.
• Effectively process all patient and third-party correspondence, including requests for copies of records and statements.
• Assist billing department with additional tasks as needed.

Position Summary
ESSENTIAL FUNCTIONS/KEY COMPETENCIES

• Function in a multi-taking, multiple priorities environment, while maintaining accuracy and attention to detail.
• Communicate with a diverse employee population.
• Utilize a wide variety of office technology and tools to collect, enter, process, file patient records and documentation.
• Education_
• High School diploma or equivalent. Must be able to speak read, write and understand English.
• Professional_
• Ability to use critical thinking skills to correctly resolve problems.
• Must have a minimum of 5 years' experience with working denied claims and submitting appeals necessary.
• FQHC experience would be helpful but not required.
• Communication, customer service or working with the general public, preferably in a medical care facility.
• General computer skills expected and ability to be trained on specific software for patient information, billing, and communication.
• Knowledge of medical terminology expected.
• Physical /Environmental_
• Ability to interact with computer screen for up to six hours at a time (visual acuity required).
• Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.
• Capacity to function in a sometimes stressful, multitasking environment
• Blood Borne Pathogen Exposure (Please Check One)_

- __Category I: Job classification includes ALL employees who have occupational exposure* to blood borne pathogens* (blood or body fluids) while performing their job duties.
- __Category II: Job classification includes employees who are likely to have SOME occupational exposure to blood borne pathogens because Category I tasks may occasionally be required.
- _X_Category


III:

Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.

LIMITATIONS/DISCLAIMER:

• The above job description is meant to describe the general nature and level of the work being performed; it is not intended to be construed as an exhaustive list of all job responsibilities, duties and skills required for the position.
• While this is intended to be