REIMBURSEMENT SPEC. COMMERCIAL PAYORS FT 5111 SCOTTSDALE
May 5, 2018
Admin / Clerical
Job Summary The Reimbursement Specialist audits commercial and government payer reimbursements for patient accounts to ensure accurate payment for services according to contractual terms agreements and government regulations. Appeals underpaid accounts and communicate with payers until resolution.
Audits commercial and government payer reimbursements for patient accounts to ensure accurate payment for services.
Reviews payer contracts for reimbursement requirements and rates.
Ensures that all activity and transactions are clearly and concisely documented in accordance with established guidelines.
Adheres to Patient Accounting Policies and Procedures as evidenced by monthly audit; Maintain quality assurance and productivity scores as determined by Leadership.
Researches and processes credit balances and refunds following payer coordination of benefits, contract terms, and/or statutes as defined in the Policy & Procedure
Interprets data processing reports and applies the information as needed for daily departmental productivity. Responds to inquiries timely:
WQ's, phone inquiries and correspondence will be responded to within the established guidelines.
Client/requester will be informed of any delays or problems encountered.
Appeals underpaid accounts with payers and follows-up on accounts through resolution.
Works and documents patient accounts according to Payment Review guidelines.
Maintains master log of underpaid accounts for tracking purposes and updates log in a timely manner.
Provides feedback and support to Manager and various departments regarding contracting and operational issues in a timely manner.
Communicates issues and provides supporting documentation when necessary regarding contracts, payers, the contract modeling system, and all patient accounting errors.
Participates in training other staff members on reconciliation techniques and other aspects of the position. Maintains current knowledge of regulatory billing requirements for all assigned payers as directed by Leadership. Attends in-service/continued education. Performs other related duties as assigned or requested
Internal Number: 2018-7799
Let’s transform healthcare together.
Every day, we bring patients convenient, coordinated access to healthcare while providing meaningful service to our community.
Join us and you will:
Develop professionally and achieve your career goals
Enrich your life with a focus on wellness
Enjoy a compassionate, caring culture with outreach to our local communities
Support the well-being of you and your family with a diverse portfolio of benefits
Welcome to HonorHealth.
We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.