Determines the extent to which patients' insurance covers their treatments.
Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation.
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Reimbursement Specialist - Healthcare skill and competencie below to view definitions.
Skill definition-Creating financial statements and reports based on the summary of financial and business transactions.
Level 1 Behaviors
(General Familiarity)
Describes the functions and benefits of accounting systems used within our business financial system.
Level 2 Behaviors
(Light Experience)
Enters data into the accounting system to produce accurate reports for requesting personnel.
Level 3 Behaviors
(Moderate Experience)
Audits transactions to ensure alignment with accounting systems and communicate discrepancies to management.
Level 4 Behaviors
(Extensive Experience)
Directs the day-to-day operations of the corporate's Accounting Department.
Level 5 Behaviors
(Mastery)
Establishes a monitoring system to evaluate compliance with GAAP and financial regulatory requirements.
Skill definition-Monitoring and tracking the inflow of money yet to be paid by the customer.
Level 1 Behaviors
(General Familiarity)
Discusses the purpose and distribution of account receivable reports.
Level 2 Behaviors
(Light Experience)
Compiles and selects files for all Accounts Receivable duties.
Level 3 Behaviors
(Moderate Experience)
Performs collection activities on accounts receivable balances to remain within corporate standards.
Level 4 Behaviors
(Extensive Experience)
Monitors document process initiatives, leading to successful collections of accounts receivables.
Level 5 Behaviors
(Mastery)
Forecasts transactions impacting accounts receivable to monitor delinquent payments.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Explains why attention to detail plays an important role in own function or unit.
Level 2 Behaviors
(Light Experience)
Processes limited amounts of detailed information with reasonable accuracy.
Level 3 Behaviors
(Moderate Experience)
Processes large quantities of detailed information with high levels of accuracy.
Level 4 Behaviors
(Extensive Experience)
Demonstrates expertise in quality assurance tools, techniques, and standards.
Level 5 Behaviors
(Mastery)
Designs techniques for measuring the cost and impact of errors.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Describes how to utilize a time management matrix for efficient completion of most important tasks.
Level 2 Behaviors
(Light Experience)
Classifies assigned tasks into specific, smaller, and more achievable goals.
Level 3 Behaviors
(Moderate Experience)
Executes work plans to manage workflow and track milestones to completion.
Level 4 Behaviors
(Extensive Experience)
Develops best techniques and methods to improve time management throughout our business.
Level 5 Behaviors
(Mastery)
Establishes a time management matrix to reprioritize the importance of current and upcoming tasks.
There are 0 hard skills for Reimbursement Specialist - Healthcare.
9 general skills for Reimbursement Specialist - Healthcare, Accounting, Accounts Receivable, Financial Reporting, etc.
5 soft skills for Reimbursement Specialist - Healthcare, Attention to Detail, Time Management, Initiative, etc.
While the list totals 14 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Reimbursement Specialist - Healthcare, he or she needs to be proficient in Attention to Detail, be proficient in Time Management, and be proficient in Initiative.
