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

About the role

Adventist HealthCare 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.

Responsibilities

• 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.
• Obtains 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.

Requirements

• 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 10 lbs).
• Atmosphere and environment associated with an office setting.
• Must maintain a professional appearance and demeanor at all times.

Schedule

• Employment Type: Full-time
• Hours per Week: 40 hours/week
• Typical Daily Schedule: 8 am-5 pm Monday through Friday
• Shift Type: Day Shift-Hybrid
• Holiday Requirements: Follow the company holiday calendar

Pay

Pay Range: $20.51 - $27.21

Under the Fair Labor Standards Act (FLSA), this position is classified as: Non-Exempt

Benefits

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D (short-term disability buy-up available)
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support