Reimbursement Specialist- Lead - Hunt Regional Healthcare : Job Details

POSITION SUMMARYResponsibilities include utilizing contract management software to determine under and/or over payments on accounts, problem solving and completing root cause analysis. Focus is placed on all payers, resolving payment variances, identifying payer trends, and providing reimbursement and status reports. Additional duties include confirmation of payer adherence to state, federal, billing and contractual guidelines. Special projects may be assigned as needed.POSITION REQUIREMENTSMinimum Education: High School graduate or equivalent. Some college preferred.Minimum Work Experience: 3-5 years' experience in medical billing and collections.Required Licenses/Certifications None.Required Skills, Knowledge, and Abilities: Knowledge of payer payment methodologies.Ability to interpret and generate written correspondence utilizing proper grammar, spelling and composition skills. Extensive knowledge, skills and abilities are required within and pertaining to the Accounts Receivable process. Intermediate Excel experience and computer knowledge required. Experience with automated systems required. Medical terminology preferred. Ability to operate office equipment, such as copy machines, fax machine and printers. Must be able to work independently with minimal supervision. Good communication skills essential. Prior experience involving public contact.Preferred Qualification: None.JOB SPECIFIC FUNCTIONS 1. Reinforces HMHD's values and promotes HMHD's Compliance Plan and understanding of applicable laws and standards. 2. Demonstrates proficiency in understanding the materials presented during the corporate integrity and compliance training and education program. 3. Attends the required corporate integrity and compliance training and education programs. 4. Ensures department employees attended (in a timely manner) the compliance training in accordance with HMHD policies. 5. Assists the Compliance Officer and the Executive Compliance Committee in identifying high risk issues within his/her department. 6. Complies with all HIPAA standards. 7. Actively participates in performance improvement, as requested; i.e. attends PI LEAN Committee meetings, submits quarterly reports, conducts audits, etc. 8. Maintains knowledge of current regulatory standards as they pertain to the department(s) and assures compliance and communication of standards. 9. Identifies departmental performance improvement opportunities and assists with the PI process. 10. Utilize contract management software to review payments posted to accounts to identify under and/or over payments. 11. Review all identified variances with in 48 hours of posting to account. 12. Validate payment was made in accordance to contract specifications and other regulatory guidelines. 13. Take corrective action to resolve payment errors (i.e. appeal, data extraction, education). 14. Collaborate with payers on correct payment determination. 15. Serve as a resource for others within the District. Assist manager, director and CFO upon request. 16. Acts as a resource for collection team members and may direct the work of other collection staff members. 17. Serves as a Subject Matter Expert and works autonomously to handle more complex issues related to the collections, within established procedures and practices. 18. Monitoring assigned carrier groups to achieve AR metrics. 19. Work within multiple systems (i.e. contract management software, HIS, acanning, etc.) while meeting production, financial, and quality goals. 20. Prepare a report summarizing appeal status, challenges and successes of accounts worked. Report to be given to Manager and Director each month. 21. Supports collection team members in problem solving and resolution as related to insurance claims. 22. Promote and demonstrate excellent customer service at all times with internal and external customers to include patients, physicians, co-workers and all other customers. 23. Communicates effectively and expresses ideas clearly, actively listens and follows appropriate channels of communication. 24. Adaptable and responsive to change. 25. Uses time clock accurately and is punctual on a consistent basis. 26. Demonstrates a positive attitude in all assigned task and towards others. 27. Follows Call-In policy by notifying PFS Leader of absence. 28. Absences during evaluation period: 0-6 Occurrences = Meets Requirements. 7 or more Occurrences = Does not meet requirements. 29. Adheres to hospital and department dress code. Maintains a professional appearance at all times. 30. Consistently contributes to the achievement of excellence in healthcare through the quality and caring values of the mission and vision of Hunt Memorial Hospital District. 31. Perform special duties and projects as assigned.