Company History
Our company is growing! We are seeking Reimbursement Specialist with knowledge in the healthcare field and worker’s compensation area.
Research Data Group’s Beacon HCI division is designed to save corporate healthcare payers millions of dollars utilizing a proprietary software tool developed with years of research and knowledge of Federal Billing Guidelines and Regulations in the healthcare industry.
The Reimbursement Specialist is responsible for performing compliance bill reviews on facility and/or hospital billings, as well as research, as necessary to determine the accuracy of the charges billed by facilities. Knowledge of Worker’s Compensation applications, as applies to general rules, reimbursement types, fee schedule, and any other rules and/or policies that would apply are also necessary to perform these compliance reviews.
Knowledge, Skills & Abilities
Worker’s Compensation Claims policy and general rules knowledge
Experience in Microsoft Office and Excel programs
Proficient data entry skills and accuracy
Ability to follow procedures
Excellent verbal and communication skills
Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards
Exceptional attention to detail
Excellent organizational, analytical, and problem-solving skills
Capable of handling multiple projects in a fast-paced, hyper-growth environment
Strong interpersonal and team-building skills
Experience and Training
Certified Professional Coder or RN/LPN
Worker’s Compensation Claims
DUTIES AND RESPONSIBILITIES
Compliance Review
Review of UB04 and detailed itemized statements
Analysis of Worker’s compensation reimbursement
Review of automated system analysis
Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes.
Perform CIA and HAC verification
Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, and routine services.
Assist with appeals as needed
Research for supporting documentation for non-billable charges
Attend required staff training and meetings
Other special projects as needed
Medical Review and Pricing Analysis
Review medical record documentation as relates to the UB04 and itemized statement
Identify compliance and billing errors as well as make appropriate documentation as relates to review performed
Obtain hospital CMS certification information
Perform DRG verification
Worker’s Compensation reimbursement review
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