REIMBURSEMENT SPECIALIST

Reimbursement Specialist

Promotes and supports the Public Health Department by providing a variety of financial, clerical, administrative, and technical support services. Responsibilities include, but are not limited to, healthcare claims processing, financial reporting, as well as other special projects as assigned. Ensures the integrity of accounting information by recording, verifying, consolidating, and entering transactions. The Reimbursement Specialist reports to the Deputy Public Health Administrator and/or their designee.

Responsibilities:

• Process and reconcile patient billing, claims, reimbursements, and revenue transactions while ensuring accuracy, compliance, and timely submission of claims.
• Review, correct, and follow up on denied, rejected, disputed, or delayed claims; maintain reimbursement records and update client accounts accordingly.
• Ensure compliance with HIPAA, Medicaid, legal, regulatory, and coding requirements; communicate coding updates and reimbursement changes to staff.
• Manage provider portals, revalidations, medical records, account databases, and reporting systems to maintain accurate records and generate required reports.
• Assist clients with intake, eligibility screening, licensing applications, referrals, and access to community and social service programs.
• Prepare correspondence, contracts, reports, grant documentation, and other administrative records while maintaining confidentiality and data integrity.
• Manage cash handling activities, including processing payments, reconciling transactions, preparing deposits, and maintaining financial records using MUNIS.
• Monitor grants and contracts to ensure compliance with objectives, deliverables, reporting requirements, and funding guidelines.
• Provide customer service by addressing inquiries, resolving concerns, processing requests, and explaining departmental procedures and regulations.
• Support departmental operations through cross-training, staff training, quality assurance activities, emergency response collaboration, meeting participation, and maintaining reliable attendance.

Knowledge, Skills, and Abilities Required:

• Working knowledge of community systems, ability to initiate referrals to community health care providers, social service, and advocacy agencies, and the ability to effectively refer clients as needed.
• Knowledge of HIPAA compliance standards and all aspects of client privacy practices.
• Knowledge/experience evaluating health trends and risk factors of target populations.
• Ability to establish professional relationships with clients, peers, supervisors and community organization members.
• Personal initiative combined with the ability to work independently and interdependently.
• Substantial working knowledge of and experience with current Microsoft Office suite or newer (Word, Excel, Outlook, PowerPoint, and Publisher), desktop publishing, and the internet, combined with the ability to pass all required skills tests.
• Previous experience working with large/specialized databases and preparing data for analysis.
• Ability to analyze data and/or manipulate data in Microsoft Excel and/or applicable databases using established criteria to determine significance and assess outcomes.
• Must be able to compare, count, measure, copy, compute, tabulate, and categorize data combined with the ability to pass all required skills tests.
• Ability to effectively acquire and utilize scientific/client data obtained from a variety of sources including patient records, lab reports, physician orders, maps, flow charts, and statistical reports.
• Ability to comprehend, utilize, and implement information from a variety of sources including personnel policies, employee performance evaluations, time study sheets, policy documents, nursing procedure manuals, scientific medical textbooks, and computer software operating manuals.
• Proficient oral/written English language skills, including proper spelling, punctuation and grammar with the ability to pass required skill tests.
• Effective oral and written communication skills at all levels of responsibility including clients and their families, physicians, local, state, and federal personnel, pharmacists, hospital and jail personnel.
• Ability to assist in the development, submission, and implementation of successful grant proposals.
• Ability to interpret, regulate, and enforce state/local/federal laws, regulations, and rules.

Minimum Qualifications:

• Associate's degree in accounting or related field and three years of experience in medical billing, coding, healthcare administration, or related office and system support, preferably in a healthcare setting, or any equivalent combination of education, training, and experience.
• A valid Wisconsin driver's license and reliable motor vehicle with mandatory levels of insurance coverage.
• Current CPR/AED/First Aid Certification or the ability to obtain such certification within six months of hire. Certifications must be maintained for the duration of employment.

Preferred Qualifications:

• Qualified applicants will possess Certified Professional Coder (CPC), Certified Coding Associate (CCA), or the Registered Health Information Technician (RHIT) required/preferred.
• Three (3) years work experience with a governmental public health agency.
• Knowledge of third party and Medicaid Billing rules and Medical Coding certification.
• Bilingual proficiency (Spanish/English).
• Customer Service experience is strongly preferred.
• Experience working with various racial and ethnic groups.
• Advanced proficiency using Microsoft Office applications (word, excel, etc.) preferred.
• Experience in public speaking with the ability to present data and other program materials in Microsoft PowerPoint.

Physical Demands of the Position:

• Standing, walking, sitting, and stooping.
• Kneeling, crouching, climbing, balancing and bending/twisting.
• Reaching, lifting, carrying, pushing/pulling (up to 35 lbs.).
• Handling, grasping, fingering, filing, typing, and writing

The City of Racine is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the City will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.