Title:- Reimbursement Specialist
Location:- San Diego, CA
Duration:- 3 Months Contract
Tax Term: W2
Schedule: Mon. - Fri., 8:00 a.m. - 5:00 p.m.
· The Director is looking for three Reimbursement Specialist I's for their Patient Financial Services. The job seekers must have prior or current Medi-Cal billing experience
· Under the direction of PFS Leadership, the Reimbursement Specialist I is responsible for billing & collections of outstanding account balances for commercial, government, & managed care payors as assigned.
· The Reimbursement Specialist I is required to identify & report payor issues to their leadership.
· It is a requirement for the Reimbursement Specialist I to read, interpret & apply complex payor contract language to expected reimbursement calculations & pursue all payments due to the organization.
· The Reimbursement Specialist I must perform account collection activities utilizing internet resources & professional telephone communication etiquette.
· The Reimbursement Specialist I is required to compose professional written correspondence with all internal & external entities.
· This position expects the Reimbursement Specialist I to demonstrate organization & time management skills to manage account collections.
• Associate's Degree (Preferred)
• H.S. Diploma,GED,or Equivalent (Minimum)
• 2 Years of Experience (Minimum)
• 3 Years of Experience (Preferred)
Skills & Qualities
• (Minimum) Proficient in Microsoft Excel, Word and Outlook programs.
Resolve all claim edits, stop bills, & account edits including late charges, charge errors, consecutive accounts, duplicate accounts, & claim errors in order to submit timely & accurate claims to government agencies, commercial payers, & other payers as assigned in accordance with federal, state, industry regulations & standards. Knowledge of HIPAA billing requirements to include claims (UB & 1500 current versions), & basic CPT coding, ICD 9/ICD10.
Ability to read & apply complex contractual arrangements to identify expected reimbursement to include fee schedules, per diems, high dollar stop loss, DRGs, APCs, & carve outs.
Review all denials/underpayments & take corrective action based upon national denial reason codes, remark codes & payer specific codes. Must understand payor-specific requirements & utilize payer websites, procedural billing manuals, & standard operating procedures.
Processes overpayments within the guidelines of federal & state regulations, payer requirements, & hospital standard procedures.
Receives & processes requests from patient families, insurance carriers, government entities, & other sources. Must provide appropriate requested information to ensure quality customer service & appropriate adjudication of claims. Compliant with Federal, state, & hospital regulations to ensure privacy is maintained in compliance with HIPAA.
Follows prescribed workflow & prioritization to ensure all accounts are being submitted & followed up on in a timely manner to include credit balances, high dollar accounts, & aging accounts. Meets department quality & productivity standards
Your prompt response is highly appreciated.
Thanks and have a blessed day ahead.
Thanks and Regards,
39899 Balentine Drive, Suite 385, Newark, CA 94560
Phone: 510-623-5050- Extn 139 / Direct: 510-943-4054