Reimbursement Specialist - Healthcare 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. Being a Reimbursement Specialist - Healthcare 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. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Job Summary
The Reimbursement Accountant is responsible for assisting the Director/Manager of reimbursement inthe accumulation and analysis of data used for the preparation of work-papers that support the hospital’ssystem third party cost reports. Input cost report data into each of the respective third party programs;assist in clarifying any ensuing audit questions concerning submitted cost report data. Assist with theanalysis of potential third party reimbursement impacts and the review of financial feasibility ofmanagement strategic planning alternatives. Assist in the preparation of the monthly system’s contractualcalculation and reconciliations to record general ledger journal entries.
Education:
High School/GED completion
Education Preferred:
Associates degree – Accounting or have equivalent hospital reimbursement cost reporting experience or Bachelor of Science degree from an accredited college or university with a concertation in Accounting or Finance.
Experience in lieu of education requirement:
Medicare Cost Reporting preparation experience. Understanding of DSH, IME / DGME and monthly contractual calculations.
Additional Skills/Abilities:Must be able to communicate effectively and work in a fast paced environment. Requiring the ability to set priorities, coordinate and organize multiple tasks without daily supervision while maintaining control of work flow. The employee will be proficient in the use of Microsoft Office spreadsheet applications. Must be able to reason and solve problems independently.
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