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%
$48,717
TOTAL 50%
$48,776
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)
Explains the basic concepts and major terminology of accounting.
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Level 2 Behaviors
(Light Experience)
Gathers accounting data and information required to generate various department reports.
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Level 3 Behaviors
(Moderate Experience)
Maintains consistency of accounts payable functions with sound accounting principles.
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Level 4 Behaviors
(Extensive Experience)
Leads the development of an accounting system to manage financial records and other information.
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Level 5 Behaviors
(Mastery)
Improves accounting procedures by analyzing current processes and adopting advanced methods.
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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)
Explains the accounts receivable cycle from entry to payment and reporting.
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Level 2 Behaviors
(Light Experience)
Follows standard operation process to perform accounts receivables.
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Level 3 Behaviors
(Moderate Experience)
Responds to all inquiries regarding accounts receivable to track clients' bank transactions.
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Level 4 Behaviors
(Extensive Experience)
Provides recommendations on the improvement of accounts receivable policies and procedures.
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Level 5 Behaviors
(Mastery)
Monitors account receivable average Days Sales Outstanding (DSO) targets.
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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)
Lists best practices and tools to maintain high accuracy and thoroughness in the workplace.
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Level 2 Behaviors
(Light Experience)
Uses checklists to ensure that information goes out error-free.
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Level 3 Behaviors
(Moderate Experience)
Sets up processes to ensure delivery of high-quality work.
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Level 4 Behaviors
(Extensive Experience)
Employs techniques for motivating personnel to meet or exceed accuracy goals.
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Level 5 Behaviors
(Mastery)
Leads the creation of tools for enhancing and assuring accuracy.
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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)
Explains the importance of time management in driving the overall productivity of our business.
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Level 2 Behaviors
(Light Experience)
Employs the 80-20 rule to avoid perfectionism and minimize time-wasting.
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Level 3 Behaviors
(Moderate Experience)
Utilizes departmental tools and best practices to organize tasks effectively and productively.
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Level 4 Behaviors
(Extensive Experience)
Manages teams in streamlining work-related tasks to prioritize highest value tasks firsts.
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Level 5 Behaviors
(Mastery)
Leads transformational changes to work plans to drive the proper utilization of time and resources.
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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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