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)
Description
GENERAL SUMMARY OF DUTIES:
This is not a remote position.
Well-versed individual, with the ability to liaison between patients, insurance companies and all of Piedmont HealthCare personnel. Will conduct skillful use of systems, communication, research, assessment and resolution. Professionally perform tasks related to accuracy in health insurance billing and collections of all transactional areas in Piedmont HealthCare patient accounts. The ability to remain focused and accurate under deadline pressure. The Insurance Specialist will retain and provide essential information to resolve any inaccuracies generated in Piedmont HealthCare patient accounts. Overall, committed to the Mission and Vision of Piedmont HealthCare’s establishment.
Requirements
REQUIREMENTS:
ESSENTIAL FUNCTIONS:
EDUCATION:
High School Diploma required, with some college preferred. Additional specialized health care related training preferred.
EXPERIENCE:
Healthcare experience required
KNOWLEDGE AND SKILL REQUIREMENTS:
ENVIRONMENTAL/WORKING CONDITIONS:
Normal office environment
PHYSICAL/MENTAL DEMANDS:
Requires prolonged sitting, some bending, stooping and stretching. Requires eye/hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing, speaking voice, and eyesight to prepare and communicate letters and reports. Requires the ability to discuss sensitive matters with patients, staff members and physicians. The position requires the ability to maintain composure when dealing with difficult people and situations.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve
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