REIMBURSEMENT SPECIALIST

Responsibilities

• Process and reconcile patient billing, claims, reimbursements, and revenue transactions while ensuring accuracy, compliance, and timely submission of claims.
• Review, correct, and follow up on denied, rejected, disputed, or delayed claims; maintain reimbursement records and update client accounts accordingly.
• Ensure compliance with HIPAA, Medicaid, legal, regulatory, and coding requirements; communicate coding updates and reimbursement changes to staff.
• Manage provider portals, revalidations, medical records, account databases, and reporting systems to maintain accurate records and generate required reports.
• Aid clients with intake, eligibility screening, licensing applications, referrals, and access to community and social service programs.
• Prepare correspondence, contracts, reports, grant documentation, and other administrative records while maintaining confidentiality and data integrity.
• Manage cash handling activities, including processing payments, reconciling transactions, preparing deposits, and maintaining financial records using MUNIS.
• Maintain compliance with grants and contracts to ensure objectives, deliverables, reporting requirements, and funding guidelines.
• Support departmental operations through cross-training, staff training, quality assurance activities, emergency response collaboration, meeting participation, and maintaining reliable attendance.

Qualifications

• Working knowledge of community systems, ability to initiate referrals to community health care providers, social service, and advocacy agencies, and the ability to effectively refer clients as needed.
• Knowledge of HIPAA compliance standards and all aspects of client privacy practices.
• Knowledge/experience evaluating health trends and risk factors of target populations.
• Establish professional relationships with clients, peers, supervisors and community organization members.
• Personal initiative combined with the ability to work independently and interdependently.
• Sufficient working knowledge of and experience with current Microsoft Office suite or newer (Word, Excel, Outlook, PowerPoint, and Publisher), desktop publishing, and the internet, combined with the ability to pass all required skills tests.
• Previous experience working with large/specialized databases and preparing data for analysis.
• Ability to analyze data and/or manipulate data in Microsoft Excel and/or applicable databases using established criteria to determine significance and assess outcomes.
• Must be able to compare, count, measure, copy, compute, tabulate, and categorize data combined with the ability to pass all required skills tests.
• Ability to effectively acquire and utilize scientific/client data obtained from a variety of sources including patient records, lab reports, physician orders, maps, flow charts, and statistical reports.
• Ability to comprehend, utilize, and implement information from a variety of sources including personnel policies, employee performance evaluations, time study sheets, policy documents, nursing procedure manuals, scientific medical textbooks, and computer software operating manuals.
• Proficient oral/written English language skills, including proper spelling, punctuation and grammar with the ability to pass required skill tests.
• Effective oral and written communication skills at all levels of responsibility including clients and their families, physicians, local, state, and federal personnel, pharmacists, hospital and jail personnel.
• Ability to assist in the development, submission, and implementation of successful grant proposals.
• Ability to interpret, regulate, and enforce state/local/federal laws, regulations, and rules.