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 Reimbursement Specialist will be responsible for proper and timely posting of payments to patients accounts. This includes reviewing and analyzing electronic remittance, receiving payments, and interpreting payor contracts to determine appropriateness in reimbursement.
SUPERVISION RECEIVED: Revenue Cycle Management.
SUPERVISION EXERCISED: None
ESSENTIAL FUNCTIONS:
Critical to this position is a knowledge of billing and medical reimbursement procedures and ability to interpret electronic remittance/correspondence from insurance companies.
DUTIES AND RESPONSBILITIES:
QUALIFICIATIONS:
PHYSICAL/MENTAL DEMANDS:
ENVIRONMENTAL/WORKING CONDITIONS:
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 and to reflect the on-going changes in office.
jobs@neurosurgerynj.com
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