Skills & Competencies for Reimbursement Specialist - Healthcare

Reimbursement Specialist - Healthcare job profile

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JOB SUMMARY for Reimbursement Specialist - Healthcare

Determines the extent to which patients' insurance covers their treatments.

JOB RESPONSIBILITIES for Reimbursement Specialist - Healthcare

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.

Reimbursement Specialist - Healthcare SALARY RANGE

BASE 50%
$48,827
TOTAL 50%
$48,886
Job Level
P02
Job Code
HC07000294
Education/Degree
Bachelor's Degree
Reports To
Supervisor or Manager

Reimbursement Specialist - Healthcare Skills and Competencies List

Proficiency Levels and Behavioural Indicators
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.
JOB FAMILY COMPETENCIES CORE COMPETENCIES
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9 general skills or competencies (Job family competencies) for Reimbursement Specialist - Healthcare

1 Job Family Competencies – Accounting
Proficiency Level -2
Skill definition-Creating financial statements and reports based on the summary of financial and business transactions.
Level 1 Behaviors
(General Familiarity)
Documents various cost accounting problems along with their relevant solutions.
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Level 2 Behaviors
(Light Experience)
Follows up with operations to ensure that approved invoices are turned in to accounting.
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Level 3 Behaviors
(Moderate Experience)
Handles various cost accounting projects to provide increasingly accurate product cost information.
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Level 4 Behaviors
(Extensive Experience)
Ensures that the timing of expenses is accurately planned for within the company's accounting policies.
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Level 5 Behaviors
(Mastery)
Establishes accounting policies to support global activities and leads its implementation.
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2 Job Family Competencies – Accounts Receivable
Proficiency Level -2
Skill definition-Monitoring and tracking the inflow of money yet to be paid by the customer.
Level 1 Behaviors
(General Familiarity)
Enters accounts receivable customer credits and deposits to the general ledger.
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Level 2 Behaviors
(Light Experience)
Discusses issues for management regarding significant changes in various accounts receivable categories.
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Level 3 Behaviors
(Moderate Experience)
Reconciles subsidiary ledgers for accounts receivable to the general ledger at the end of the month.
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Level 4 Behaviors
(Extensive Experience)
Presents findings of accounts receivable information to keep accounts current.
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Level 5 Behaviors
(Mastery)
Keeps operational criterion reflected in the accounts receivable functions.
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3 Reimbursement Specialist - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Reimbursement Specialist - Healthcare
Proficiency Level - 4
5 Competency for - Reimbursement Specialist - Healthcare
Proficiency Level - 5

5 soft skills or competencies (core competencies) for Reimbursement Specialist - Healthcare

1 Core Competencies – Attention to Detail
Proficiency Level -2
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Identifies the procedures for making sure that results are mistake-free.
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Level 2 Behaviors
(Light Experience)
Records all appointments on the calendar to easily track daily activities.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes the accuracy of data and details.
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Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
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Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
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2 Core Competencies – Time Management
Proficiency Level -2
Skill definition-Managing and setting priorities, goals, and timetables to boost productivity and efficiency in completing tasks.
Level 1 Behaviors
(General Familiarity)
Discusses workplace barriers and issues that may affect time management.
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Level 2 Behaviors
(Light Experience)
Collects and compiles information in an organized manner to finish tasks efficiently.
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Level 3 Behaviors
(Moderate Experience)
Handles workplace obstacles to maintain focus and manage time efficiently.
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Level 4 Behaviors
(Extensive Experience)
Improves processes to organize workloads of teams efficiently.
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Level 5 Behaviors
(Mastery)
Keeps current on the latest working models on time management to drive organizational productivity.
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3 Reimbursement Specialist - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Reimbursement Specialist - Healthcare
Proficiency Level - 4
5 Competency for - Reimbursement Specialist - Healthcare
Proficiency Level - 5

Summary of Reimbursement Specialist - Healthcare skills and competencies

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.

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