Reimbursement Specialist; Hybrid), Day Shift, Patient Financial Services

Remote

If you are a current Adventist Health Care employee, Adventist Health Care seeks to hire an experienced Reimbursement Specialist for our Patient Financial Services department who will embrace our mission to extend God’s care through the ministry of physical, mental and spiritual healing.

• Demonstrates excellent patient service skills, assists in problem resolution both internal and external.
• Demonstrates world class exceptional customer service and set example of correct phone etiquette.
• Promote teamwork and a positive work environment.
• Communicates to management when issues arise.
• Demonstrates an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management.
• Assist with training of new team members.
• Independently problem solves and identifies opportunities for improvement.
• Completes tasks assigned in a timely and efficient manner in accordance with department policy.
• Follows up on billed and/or denied accounts with third party payers.
• Demonstrates ability to troubleshoot and elevate appropriate issues to management.
• Raises awareness of payer related trends to management with supporting data.
• Submits adjustment requests for services deemed uncollectable.
• Verifies Coordination of Benefits for all insurance provided.
• Demonstrates excellent customer service skills, assists in problem resolution both internal and external.
• Other duties as assigned.
• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of denial or partially paid claim.
• Contacts payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
• Obtain payment or commitment from payer to pay.
• Obtains status on billed, resubmitted, appealed and reconsideration claims.
• Determines if claim is on file.
• Files appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
• Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contacts payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
• Routes denial to the appropriate team after denial has been determined that another department should resolve.
• Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers unpaid balance to patient once patient responsibility has been determined.
• Reviews Explanation of Benefits for clarity.
• Processes payer changes as needed.

• High School Diploma required, or some college preferred.
• A minimum of 3 years’ experience within a healthcare environment can include insurance company, public health setting or an outsourcing company.
• Frequent pressure due to time constraints
• Frequently works at PC involving focused concentration.
• Frequent walking, standing, bending, kneeling/crouching, sitting etc.
• Light physical effort (lifts or carries up to 10lbs)
• Atmosphere and environment associated with an office setting.
• Must maintain a professional appearance and demeanor at all times.

Employment Type:

Full-time Hours per Week: 40 hours/week Typical Daily

Schedule:

8 am- 4:30 pm Monday through Friday Shift Type:
Day Shift-Hybrid Schedule Holiday Requirements:
Follow company holiday calendar Pay Range: $20.51 - $27.21 If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process. Under the Fair Labor Standards Act (FLSA), this position is classified as:
United States of America (Non-Exempt)

• Work life balance through nonrotating shifts
• Recognition and rewards for professional…