Hybrid​/On Site Reimbursement Specialist

About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through Village

MD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: , , , , , , or

Hybrid/On Site - Bend Oregon

The Reimbursement Specialist is responsible for claim management, denial management and aged unpaid claim follow up. Responsible for processing insurance claims for various types of insurance and maximizing SMGOR reimbursement. Responsible for claim resolution through working claims edits and appealing denied claims in a timely manner. Track status of outstanding claims, follow up on outstanding AR balances and monitoring of payer response.

Provide detailed information regarding problem payers to management; provide suggestions for solutions to management.

• Monitoring and working in the work queues for assigned providers and specialties, to include researching and correcting claims, writing appeals and facilitating their submission for appealing adverse decisions, contacting payers as needed, and all other activities that lead to the successful adjudication of eligible claims.
• Any payer specific coding and charge entry based on assigned providers and specialties.
• Completing claims worklists assigned by Reimbursement Supervisor.
• Complete system knowledge to include credit work queues. Have the ability to research and resolve over payments for insurance and self-pay.
• Responsible for monitoring contractual allowances.
• Reviews and analyzes EOBs for identified under allowed claims.
• Researches and resolves billing errors including resubmission of claims to insurance companies. Make any necessary corrections/refunds.
• Compiles and submits appeals, and monitors for proper reimbursement according to current contract.
• Provide CPT and contract analysis reports as requested.
• Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties.
• Receive transferred calls or emails from Patient Accounts staff from insurance companies requesting advanced assistance with their patient account.
• Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.
• Perform payment posting and charge entry as needed.

• Proficient in EMR/EHR.
• Proficient in management and resolution of items in the work queues
  • Rules versus denials
  • Claim edits: what they are and what they do.
  • Claim note history including actions and claim statuses
  • Payer Rejections
  • Utilizing and managing payer websites
  • Sorting in work queue to prioritize daily as assigned

• Proficient in explanation of benefits (EOBs) and electronic remittance advice (ERA) reason and remark codes provided by the payers.
• Proficient in working claim edit work lists
  • Claim attachment
  • Corrected claim attachment
  • Payer specific edit

• Exhibit strong communication skills with internal players including physicians, providers, peers, and your supervisor/manager
• Exhibit strong communication skills in claim notation, appeals and payers.

• Understanding of generally accepted insurance benefit terms and processes.

• Understanding of Documents Table, Registration, and Claim Edit screens. All screens, tools and data locations available under the user’s security access.

• Understanding of request/preparation of supporting documentation such as medical records, dictation,…