Reimbursement Specialist - Healthcare jobs in Hartford, CT

POSTING NUMBER: (N267-2324)

POSTING DATE: February 26, 2024

CLOSING DATE: March 8, 2024

POSITION: Third Party Reimbursement Specialist

REPORTS TO: Director of Nursing and Clinical Services

POSITION SUMMARY: Assist the Director of Nursing and Clinical Services in gathering data and preparing statements for filing insurance claims to all third party payers with primary emphasis on generating revenue from dental and medical clinic sites.

RESPONSIBILITIES & ESSENTIAL FUNCTIONS:

• Responsible for all aspects of generating and documenting third party revenue
• Responsible for service documentation and productivity as it relates to revenue production at clinic sites
• Adhere to established internal controls
• Responsible for composing correspondence to providers and monthly reports to department director and director of finance
• Responsible for arranging meetings with DSS
• Ensures that supporting documentation is provided at time of claim submission to facilitate timely reimbursement
• Responsible for submission of HCFA-1500 and Dental ADA claim forms (electronic or paper) to third party carriers
• Implement procedures and improve efficient and effective operations for the billing unit
• Responsible for performing verification through HP (formerly EDS) to determine patient eligibility status
• Ensures that medical and dental claims meet billing guidelines for assigned carriers
• Maintains tracking system to ensure claim submission to carrier billing requirements
• Ameliorate medical and dental EOB’s (explanation of benefits) to ensure payments on claims processed
• Responsible for adjudicating denied claims
• Assist in revisions to SBHC database and billing process
• Responsible for correspondence and deadlines on medical and dental contracts
• Responsible for contacting insurance companies on patients with outstanding claims
• Performs other duties as assigned by supervisor

QUALIFICATIONS:

• Bachelor’s degree from accredited college and a minimum of five years’ experience working in a school district or related setting. The degree requirement may be substituted by at least 10 years of experience working in health related area.
• Experience in third-party payer billing and reimbursement procedures and practices.
• Ability to examine documents for accuracy and completeness and prepare claims according to detailed instructions.
• Knowledge of various insurance programs (HMO, PPO, etc.).
• Excellent mathematical skills and the ability to perform various math calculations.
• Working knowledge of general accounting standards and practices.
• Excellent technology and computer skills with a particular facility for Microsoft office productivity software.
• Experienced at using district systems, databases and other online resources.
• Excellent written and verbal communication skills.
• Excellent time management and organizational skills.
• Ability to establish and maintain working relationships with all levels of administration.
• Ability to work under stressful situations and within specific time constraints.
• Experience coordinating multiple projects at once.
• Ability to work independently.
• Ability to work an extended day if necessary.

CERTIFICATION: N/A

SALARY AND TERMS OF EMPLOYMENT: 12-month work year. Salary Grid: C515 ($67,194-$80,931)

EVALUATION: Evaluated annually

UNION AFFILIATION: Hartford Educational Support Personnel (HESP)

APPLICATION PROCEDURE: To be considered, all internal and external applicants must fully complete a Hartford Public Schools’ online application, which can be accessed through our Applicant Tracking System, Nimble, at https://app.hirenimble.com/jobs/hartford. Internal applicants should use a personal email address when applying. Please do not use your hartfordschools.org email. Candidates’ application and supporting documents will be reviewed. Candidates who advance through the initial review will be notified and placed in the pool for consideration by hiring managers. Candidates will be contacted directly by hiring managers for interviews.