AACP Certified Reimbursement Specialist

AACP Certified Reimbursement Specialist

Spring Lake, NC $52,089 - $67,099 a year

Join a dedicated healthcare team as a Reimbursement Specialist focused on cancer center revenue cycle management. This role involves coordinating pre-authorizations, medical necessity reviews, physician communication, charge reviews, and billing inquiries. You will manage workqueues and serve as a key resource for billing compliance and medical necessity guidelines.

Key Responsibilities

• Educate patients on insurance processing, including co-pays, deductibles, and denials.
• Coordinate with insurance providers to confirm benefits and obtain prior authorizations for chemotherapy, radiation therapy, and diagnostic testing.
• Collaborate with Financial Navigators to assist uninsured patients in qualifying for Medicaid or charitable services.
• Work closely with physicians to ensure understanding of medical necessity rules, especially for off-label drug use.
• Monitor insurance denials and manage appeals effectively.
• Apply knowledge of CPT-4, HCPCS, UB-04 codes, and coverage guidelines to ensure accurate billing.
• Stay informed on regulatory changes and coordinate with management to maintain compliance.
• Provide guidance to medical and clerical staff on billing and medical necessity requirements.

Education

High school diploma or equivalent required; Associate's degree preferred. CHONC (Certified Hematology and Oncology Coder) certification is highly desirable.

Experience

3 to 5 years of experience in hospital business office, financial planning, or physician office settings. Strong understanding of billing compliance with government programs such as Medicare, Medicaid, and Champus is essential.

Skills and Abilities

• Proficient in managing workqueues independently and meeting deadlines with accuracy.
• Experience with Microsoft Office and Electronic Medical Records (EMR) systems.
• Strong financial acumen and ability to interpret federal and state regulations.
• Excellent communication skills to interact effectively with team members and management.

This position serves a diverse regional population in the Southeastern United States, offering a collaborative and supportive work environment.

MLee Healthcare Staffing and Recruiting, Inc