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)
The Clinical Documentation Improvement (CDI) Specialist performs concurrent review of the inpatient medical record throughout the patient stay in order to ensure that the clinical documentation reflects the patient’s severity of illness and quality of care. The CDI Specialist communicates with physicians, clinicians, Coding and HIM professionals, nursing staff and Care Management to ensure timely and accurate documentation and provides training and education as needed. The CDI Specialist will also perform focused reviews as directed by the department supervisor.
Three (3) years of clinical experience as a registered nurse in an acute care setting; OR three (3) years’ experience certified coding for the acute care inpatient setting.
Current nursing licensure by the Georgia State Board of Nursing or Certified Coding Specialist (CCS) or Certification in Clinical Documentation Improvement Practitioner. (CCDS/CDIP).
Successful candidates will be subject to criminal background and drug screens.
EOE/AA/Females/Minorities/Veterans/Disabled
0 Reimbursement Specialist - Healthcare jobs found in Macon, GA area