We are searching for a Sr. Reimbursement Specialist – someone who works well in a fast-paced managed care setting. In this position, you will design, develop, and manage the denial and underpayment databases for Patient Accounting. This role will primarily be responsible for monitoring and tracking managed care reimbursement and denials to provide weekly, monthly, and yearly reports to management of trends.
Think you’ve got what it takes?

SKILLS & REQUIREMENTS

• High School Diploma or GED
• 7 years of experience in accounting, contracting, collections, provider relations, or patient access area
• A Bachelor’s degree may substitute for 4 years of the required experience
• Knowledge of State, Federal, and third-party claims processing and the laws of the State Insurance Board and Fair Collection Act
• Understand all types of managed care payment plans such as HMO’s, PPO’s, POS, and EPO plans

• Creates and maintains denial and underpayment databases to ensure that all denied and underpaid accounts are identified and trended to improve collections and reduce denials
• Assists Patient Account Managers with training in resolving reimbursement issues related to managed care and other discounted accounts
• Meets with payers to maintain productive relationships with the insurance companies, managed care organizations, and government agencies to resolve reimbursement and slow payment problems
• Provides weekly, monthly, and annual reports for Business Service Leadership and VP of Finance to manage and monitor Accounts Receivable and Revenue Cycle
• Provides period audits on accounts by payer to ensure that accounts are reimbursed appropriately, and contractual discounts are recorded accurately
• Develops reimbursement reports for the Health Centers and Learning Support centers
• Works closely with Decision Support team to ensure that reimbursement and collections data is accurate
• Develops and maintains positive relationships with physicians, providers, and practice managers throughout the delivery system
• Actively participates in the development and implementation of the action plans for the department in response to Business Services adoption of Continuous Quality Improvement