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)
Lists and explains the essential tools used for managing accounting records and information.
Level 2 Behaviors
(Light Experience)
Supports accounting operations by processing and maintaining accurate records of financial transactions.
Level 3 Behaviors
(Moderate Experience)
Works with external auditors on various accounting matters.
Level 4 Behaviors
(Extensive Experience)
Monitors data flow through accounting to ensure accuracy.
Level 5 Behaviors
(Mastery)
Stays current and integrates major accounting systems, methods, and practices used worldwide.
Skill definition-Monitoring and tracking the inflow of money yet to be paid by the customer.
Level 1 Behaviors
(General Familiarity)
Follows up on collated documents to ensure that the information is appropriate and accurate.
Level 2 Behaviors
(Light Experience)
Supports the daily management of all accounts receivable balances to ensure timely payment.
Level 3 Behaviors
(Moderate Experience)
Uses various collection techniques to keep accounts receivable current, including monitoring for delinquent payments.
Level 4 Behaviors
(Extensive Experience)
Reviews outstanding accounts receivable balances for prompt payment.
Level 5 Behaviors
(Mastery)
Plays as an expert resource for the team on accounts receivable matters.
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists the traits of an employee showing great attention to detail.
Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Lists basic planning tools and applications used in tracking and organizing time and tasks visually.
Level 2 Behaviors
(Light Experience)
Seeks all resources needed to accomplish a task efficiently and effectively.
Level 3 Behaviors
(Moderate Experience)
Works closely with colleagues to identify and reduce interruptions and barriers to time utilization.
Level 4 Behaviors
(Extensive Experience)
Provides strategic direction to the workforce in managing time to avoid low-value work.
Level 5 Behaviors
(Mastery)
Monitors the performance of business units to determine and eliminate deviations from priorities.
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.
