Reimbursement Specialist

Location
Gaithersburg, MD
Posted
Aug 20, 2018
Closes
Sep 28, 2018
Function
Customer Service
Industry
Healthcare
Hours
Full Time
Support Center

If you are a current Adventist HealthCare employee, please click this link to apply through your Workday account. The Reimbursement Specialist has the primary responsibility of the daily reimbursement activities for claims submitted to third party payers. This position demonstrates a working knowledge of revenue cycle and reimbursement functions and a basic understanding of coding and billing requirements including ICD10, UB04, HCPCS and CPT (Current Procedural Terminology).

The Reimbursement Specialist maintains a working knowledge of Federal, State, and/or Managed Care requirements and is capable of independently executing responsibilities
Work Schedule:


  • The reimbursement specialist determines root cause of denial or partially paid claim.
  • 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.
  • Routes denial to the appropriate team after denial has been determined that another department should resolve.
  • Contacts payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
  • Requests Rebill/Corrections if denial has been reviewed and it is determined that a rebill is needed.
  • 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 determined patient responsibility.
  • Reviews Explanation of Benefits
  • Processes Payer changes if update or change is needed

Tobacco Statement


Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.


Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.



Equal Employment Opportunity


Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.


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