Reimbursement specialist job description
Updated March 14, 2024
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Example reimbursement specialist requirements on a job description
Reimbursement specialist requirements can be divided into technical requirements and required soft skills. The lists below show the most common requirements included in reimbursement specialist job postings.
Sample reimbursement specialist requirements
- Experience in medical billing and coding
- Knowledge of healthcare laws and regulations regarding reimbursement
- Strong analytical and problem-solving skills
- Proficiency in Microsoft Office and other relevant software
- Excellent attention to detail and accuracy
Sample required reimbursement specialist soft skills
- Excellent communication and interpersonal skills
- Ability to work independently and in a team environment
- Strong organizational and time management skills
- Positive attitude and willingness to learn
- Ability to handle confidential information with discretion
Reimbursement specialist job description example 1
Atrium Health Floyd reimbursement specialist job description
Performs duties of mid to intermediate complexity. Applies CPT and ICD codes to ensure appropriate revenue generation and compliance with billing guidelines.
Essential Functions
Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered. Appends all modifiers. Ranks CPT codes when multiple codes apply. Assigns Evaluation and Management (E/M) codes. Performs reconciliation process to ensure all charges are captured. Processes automated or manually enters charges into applicable billing system. Researches, answers, and processes all edits associated with claim and coding submission. Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met. Communicates with providers related to coding issues that are of mid to intermediate complexity. Including face to face interaction and education with providers. Applies modifiers and appropriate ranking to encounters with multiple codes.
Physical Requirements
Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending.
Education, Experience and Certifications
High School Diploma or GED required. Minimum of 1 year of coding experience required. CPC or equivalent coding credential required. Maintain coding certification (CPC, CCS, RHIT, RHIA). Working knowledge of coding, medical terminology, anatomy, and physiology. Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers Understanding of and familiarity with regulatory guidelines including NCDs and LCDs.
About Us
Atrium Health is one of the nation's leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region's largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care.
We've been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors' offices to behavioral health centers to nursing homes.
Our focus: Delivering the highest quality patient care, supporting medical research and education, and joining with partners outside our walls to keep our community healthy.
About the Team
Our Mission Statement, Vision and Values
Our Mission: To improve health, elevate hope and advance healing - for all.
Our Vision: To be the first and best choice for care.
Our Values: We recognize that employees are our most valuable asset. We have identified four core values we hold in the highest regard: caring, commitment, integrity and teamwork.
Essential Functions
Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered. Appends all modifiers. Ranks CPT codes when multiple codes apply. Assigns Evaluation and Management (E/M) codes. Performs reconciliation process to ensure all charges are captured. Processes automated or manually enters charges into applicable billing system. Researches, answers, and processes all edits associated with claim and coding submission. Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met. Communicates with providers related to coding issues that are of mid to intermediate complexity. Including face to face interaction and education with providers. Applies modifiers and appropriate ranking to encounters with multiple codes.
Physical Requirements
Works in a fast-paced office/hospital environment. Work consistently requires sitting and some walking, standing, stretching, and bending.
Education, Experience and Certifications
High School Diploma or GED required. Minimum of 1 year of coding experience required. CPC or equivalent coding credential required. Maintain coding certification (CPC, CCS, RHIT, RHIA). Working knowledge of coding, medical terminology, anatomy, and physiology. Knowledge of and the ability to apply payer specific rules regarding coding, bundling, and adding appropriate modifiers Understanding of and familiarity with regulatory guidelines including NCDs and LCDs.
About Us
Atrium Health is one of the nation's leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region's largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care.
We've been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors' offices to behavioral health centers to nursing homes.
Our focus: Delivering the highest quality patient care, supporting medical research and education, and joining with partners outside our walls to keep our community healthy.
About the Team
Our Mission Statement, Vision and Values
Our Mission: To improve health, elevate hope and advance healing - for all.
Our Vision: To be the first and best choice for care.
Our Values: We recognize that employees are our most valuable asset. We have identified four core values we hold in the highest regard: caring, commitment, integrity and teamwork.
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Reimbursement specialist job description example 2
Children's Hospital Colorado reimbursement specialist job description
60306BRJob Posting Title:Reimbursement SpecialistDepartment:Physician's OrganizationAutoReqId:60306BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:AdministrationJob Posting Description:
This Reimbursement Specialist will be responsible to:
+ Review hospital and or physician service contracts and fee schedules. Staff the Department's Fee Committee. Prepare analyses for review by committee. Make recommendations regarding contract terms and fees.
+ Develop rate setting recommendations for all services rendered by the department. Prepares reimbursement analyses. Maintain rate schedules for hospital and physician billing systems.
+ Maintain, update and develop charge tickets for all divisions and programs in department. Work with clinical practice managers and clinical service managers to develop appropriate lists of charges and diagnosis codes.
+ Maintain, update and develop case mix models using hospital and physician billing data. Analyze actual data for outliers, physician activity, etc.
+ Maintain, update and develop program and provider statistical reports for inpatient and outpatient activity. Provide regular reporting to various groups and individuals. Work with ISD to develop appropriate and accurate reporting.
+ Maintain, update and develop physician incentive accounting system using both hospital and physician data. Investigate and recommend different models of incentive plans to department leadership.
+ Maintain, update and may develop a cost accounting system for patient care activities working with clinical directors and management staff to identify costs.
+ Assist management with the development of clinical general fund and service fund budgets. Monitors budget performance and coordinates variance reporting. Prepare appropriate budget analyses to measure performance.
+ Maintain, update and may develop reimbursement systems including capitation and fee for service models. Monitor and apply Resource Based Relative Value System (RBRVS) for department. May recommend changes in fees.
To qualify, you must have:
+ The knowledge of theories, principles, and concepts typically acquired through completion of a Bachelor's degree in Accounting or a closely related field.
+ The analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems or design relatively complex systems and programs that cross department and or divisional lines.
+ Excellent communication and writing skills
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes (50% off). Discover your best.
Office/Site Location:BostonRegular, Temporary, Per Diem:Regular
This Reimbursement Specialist will be responsible to:
+ Review hospital and or physician service contracts and fee schedules. Staff the Department's Fee Committee. Prepare analyses for review by committee. Make recommendations regarding contract terms and fees.
+ Develop rate setting recommendations for all services rendered by the department. Prepares reimbursement analyses. Maintain rate schedules for hospital and physician billing systems.
+ Maintain, update and develop charge tickets for all divisions and programs in department. Work with clinical practice managers and clinical service managers to develop appropriate lists of charges and diagnosis codes.
+ Maintain, update and develop case mix models using hospital and physician billing data. Analyze actual data for outliers, physician activity, etc.
+ Maintain, update and develop program and provider statistical reports for inpatient and outpatient activity. Provide regular reporting to various groups and individuals. Work with ISD to develop appropriate and accurate reporting.
+ Maintain, update and develop physician incentive accounting system using both hospital and physician data. Investigate and recommend different models of incentive plans to department leadership.
+ Maintain, update and may develop a cost accounting system for patient care activities working with clinical directors and management staff to identify costs.
+ Assist management with the development of clinical general fund and service fund budgets. Monitors budget performance and coordinates variance reporting. Prepare appropriate budget analyses to measure performance.
+ Maintain, update and may develop reimbursement systems including capitation and fee for service models. Monitor and apply Resource Based Relative Value System (RBRVS) for department. May recommend changes in fees.
To qualify, you must have:
+ The knowledge of theories, principles, and concepts typically acquired through completion of a Bachelor's degree in Accounting or a closely related field.
+ The analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems or design relatively complex systems and programs that cross department and or divisional lines.
+ Excellent communication and writing skills
Boston Children's Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, and discounted rates on T-passes (50% off). Discover your best.
Office/Site Location:BostonRegular, Temporary, Per Diem:Regular
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Reimbursement specialist job description example 3
ProMedica Toledo Hospital reimbursement specialist job description
ProMedica Senior Care is hiring for a Clinicial Reimbursement Specialist to cover our California region!
The Clinical Reimbursement Specialist is responsible to review Medicare/Medicaid documentation to assist nursing centers in completing MDS to ensure appropriate levels of Medicare and/or Medicaid reimbursement. Works with RDOs, Administrators, and facility staff in training/consulting on traditional Medicare A coverage, documentation, and eligibility. As part of a regional team (MRBS, RRM, CMS), assists with monitoring medical records requests for M2 and Managed Medicaid payers to ensure they are tracked and responded to in a timely manner. This role will cover skilled nursing facilities in the California Region and candidates must live in that area.
Responsibilities:
Monitors that facilities follow Medicare/Medicaid regulatory and HCR ManorCare guidelines.
Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
Reviews MDS documentation for accuracy and appropriateness
Monitors and assists with validation of Quality Measures report for accuracy of MDS coding.
Assists with developing and presenting training materials for MDS training sessions. .
Participates in interviews of DCD and MDS Coordinators.
Performs audits per company standards and policies to ensure appropriate levels of reimbursement.
Monitors Corporate Compliance policies and notifies appropriate facility, regional, divisional, and corporate staff as needed.
Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
Coaches facility ADNS, Administrators, and other staff as to proper procedures for M2 medical records requests, and Part A ADRs and Appeals.
Makes recommendations regarding eligibility and coverage for Medicare Part A.
Monitors M2 (Medicare, Managed Care) and Managed Medicaid records requests, with the regional team, to ensure they are tracked and responded to in a timely manner.
Location
000 - California, any location
Educational Requirements
Graduate of an approved Registered Nurse program and RN licensed in the state of practice required.
Position Requirements
Minimum of 2 years of nursing experience in a Skilled Nursing Facility preferred. Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. Thorough understanding of the Quality Indicator process. Knowledge of the OBRA regulations and Minimum Data Set. Knowledge of the care planning process.
The Clinical Reimbursement Specialist is responsible to review Medicare/Medicaid documentation to assist nursing centers in completing MDS to ensure appropriate levels of Medicare and/or Medicaid reimbursement. Works with RDOs, Administrators, and facility staff in training/consulting on traditional Medicare A coverage, documentation, and eligibility. As part of a regional team (MRBS, RRM, CMS), assists with monitoring medical records requests for M2 and Managed Medicaid payers to ensure they are tracked and responded to in a timely manner. This role will cover skilled nursing facilities in the California Region and candidates must live in that area.
Responsibilities:
Monitors that facilities follow Medicare/Medicaid regulatory and HCR ManorCare guidelines.
Remains abreast of regulatory change for Medicare/Medicaid reimbursement and communicates necessary information to appropriate personnel.
Reviews MDS documentation for accuracy and appropriateness
Monitors and assists with validation of Quality Measures report for accuracy of MDS coding.
Assists with developing and presenting training materials for MDS training sessions. .
Participates in interviews of DCD and MDS Coordinators.
Performs audits per company standards and policies to ensure appropriate levels of reimbursement.
Monitors Corporate Compliance policies and notifies appropriate facility, regional, divisional, and corporate staff as needed.
Collaborates with corporate and/or facility staff related to denial issues affected by the MDS.
Collaborates with the facility to keep them informed of new developments for Federal and State payment systems.
Coaches facility ADNS, Administrators, and other staff as to proper procedures for M2 medical records requests, and Part A ADRs and Appeals.
Makes recommendations regarding eligibility and coverage for Medicare Part A.
Monitors M2 (Medicare, Managed Care) and Managed Medicaid records requests, with the regional team, to ensure they are tracked and responded to in a timely manner.
Location
000 - California, any location
Educational Requirements
Graduate of an approved Registered Nurse program and RN licensed in the state of practice required.
Position Requirements
Minimum of 2 years of nursing experience in a Skilled Nursing Facility preferred. Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. Thorough understanding of the Quality Indicator process. Knowledge of the OBRA regulations and Minimum Data Set. Knowledge of the care planning process.
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Updated March 14, 2024
Updated March 14, 2024