Reimbursement Specialist 2, Zero Balance

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Essential Functions:

• Communicate with payer representatives via phone, provider portals, written correspondence etc. to identify claim status, needed documentation, reasoning for denial/underpayment and route claims for appropriate processing.
• Identify trends in workflow and make recommendations to address them efficiently. Communicate trends in biweekly team meetings.
• Adhere to account specific strategies (e.g.,- escalation, contesting processing outcomes, appeal, obtaining audit reports, requesting claim correction, etc.) to resolve accounts expeditiously.
• Manually reprice claims via payer-provider contracts or CMS methodologies, IPPS/OPPS & Medicaid and determine source of underpayment.
• Engage in client write-off process by incorporating project specific criteria and safeguarding project profitability.
• Integrate newly identified information and adapt strategy appropriately.
• Draft concise customized correspondence and submit necessary documentation while adhering to payer processes and professional etiquette. 
• Train and onboard new team members.
• Manage multiple projects while adhering to deadlines.
• Other duties as assigned.

Competencies: Knowledge, Skills & Abilities:

• Associate Degree or 3-5 years relevant work experience preferred
• Experience in areas of math and analysis with a focus on complex medical claims and repricing for full reimbursement
• Intermediate knowledge of key risk areas of contract reimbursement methodologies (e.g. fee schedules, case rates, IPPS, OPPS, outliers, carve outs)
• Intermediate understanding of contractual reimbursement method acronyms (e.g. COB: BLP, BC max, carve-out, OPPS) 
• Must be able multi-task and remain diligent with workload/multi-project while maintaining strong attention to detail
• Excellent written and verbal communication skills
• Ability to interact with customer service representatives in a persistent and professional manner
• Strong computer skills, including MS Office (Access, Word, Excel including pivot tables, data export and analysis)
• Must be able to work autonomously, to solve reimbursement issues as well as work within a team to identify alternate solutions

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.