Medical Reimbursement Specialist

About the role

The Reimbursement Specialist, Utilization Review, plays a crucial role in ensuring that home health clients receive the necessary authorization for their care under managed care insurance plans. This involves reviewing clinical information in the medical record to accurately request authorization for visits, start and end dates, and disciplines requiring authorization.

Responsibilities

• Review and interpret clinical information in the medical record to submit authorization requests for home health clients with managed care insurance plans.
• Communicate with clinicians (or the interdisciplinary team) as needed to obtain additional clinical information required by insurance case managers.
• Demonstrate excellent critical thinking and decision-making skills when reviewing documentation in the medical record and including appropriate clinical information on all authorization requests.
• Ensure compliance with Main Line Health Home Care and Hospice policies and procedures.

Requirements

• Minimum of two years related experience in a service-oriented or health-related organization.
• Experience in computers with knowledge of Microsoft Office, E-mail, and Windows applications.
• Keyboard skills of 40 to 45 WPM.
• Excellent interpersonal, communication, and organizational skills.
• Ability to read, write, speak, understand, and communicate in English sufficiently to perform job duties.
• Working knowledge of home care and medical terminology.
• Working knowledge of managed care authorization procedures.
• Knowledge of HCPCS/CPT/ICD-10 and revenue codes.

Qualifications

• High School Graduation or Equivalent with additional training in computers.
• Associates degree or higher preferred.

Skills

• Attention to detail.
• Excellent critical thinking and decision-making skills.
• Effective communication and interpersonal skills.
• Organizational skills.

Benefits

• Up to 120 hours of paid time off per year.
• Employee discounts on various activities, services, and vendors.
• Free employee parking.

Pay

This position is eligible for up to $6,000 per year based upon Full or Part Time status.

Schedule

Monday - Friday; Day Shift plus 1 weekend per month.