Reimbursement Specialist

Reimbursement Specialist Location: BHG Bronson Healthcare Group Shift First Shift Time Type Full time Scheduled Weekly Hours 40 Responsibilities Performs duties necessary to facilitate payment from third‑party payers. This includes correct billing, statusing and collection from third parties, posting third‑party payments, computing correct reimbursement, processing incoming and outgoing correspondence, and maintaining a working knowledge of current contracts and government regulations for multiple entities. Ensure claims are compliant with all payer specifications, State, Federal and HIPAA regulations. Resolve billing issues up front to promote better reimbursement and reduce outstanding revenue. Prepare documentation to maximize reimbursement. Analyze assignment of all CPT‑4, ICD‑9, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third‑party payers. Critically analyze and process third‑party and internal information requests and rejections to resolve accounts receivable. Critically analyze and process documents for resolution of third‑party liabilities, outstanding credits and un‑billed accounts. Post adjustments and refunds to accounts, and critique contractual allowances and other arrangements. Apply current contracts and governmental regulations, including referrals for legal intervention for multiple entities. Operate multiple computer systems (STAR, EC2000, EPIC, SSI, GLMI Home Health Billing, payer claims and eligibility systems). Verify insurance eligibility using automated online systems. Qualifications Strong computer and general office equipment knowledge required. Knowledge of medical terminology, ICD‑9, CPT‑4 coding, National Billing forms, third‑party payers, managed care, reimbursement and regulatory compliance preferred. Typing speed of 45 words per minute is necessary. Effective communicator with patients, customers and co‑workers. Able to quickly analyze communication style based on nature and approach of verbal inquiry. Education & Experience High school diploma or GED required. Associate’s degree in business or finance, or equivalent experience in medical billing, receivables or collection preferred. Certification Successfully pass EUPA for all Epic applications associated with the position within the first 90 days in the position. #J-18808-Ljbffr