Reimbursement Specialist II (Hybrid)
San Ysidro Health Center - san diego, CA
Apply NowJob Description
Position Summary: The Reimbursement Specialist II is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims. They are responsible for payer follow up and appealing of denied encounters to ensure accuracy of reimbursement. Essential Functions of the Job: Prepares accounts and encounters for accuracy for billing; prepare, review, and transmit claims using automated systems and manual paper claim process Provides any required attachments to third party claims including authorizations and EOBs to ensure timely payment for the third-party payer Changes system financial settings once primary insurance has paid to ensure that co-payments and deductibles are generated to guarantors Identify and bill secondary payers Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates Performs adjustment write off(s) keying and posting via computer input after obtaining approval signatures if required Performs timely follow up on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents Documents all analysis findings, phone calls and correspondence in the online practice management system Respond to all patient or insurance telephone inquiries to ensure timely reimbursement Must maintain assigned Accounts Receivable at or below goal on a consistent basis Attends meeting and training classes as required by departmental or facility management Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety and infection control standards Functions as a resource on assigned Accounts Receivable category to all staff and may assist with training Attends training required by the State or Federal Government and Insurance plans to insure compliance to billing rules and regulations Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws Must be able to track denials for the purpose of denials trending and management to report back to management The ability to read and interpret contract language is an essential function of the Reimbursement Specialist II The Reimbursement Specialist II must be able to successfully prepare an appeal for a denial and receive accurate reimbursement Additional Duties and Responsibilities: Any and all duties as assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors Job Requirements Experience Required: Minimum of 3 years' experience in a medical billing department Must also demonstrate knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology Education Required: High School Diploma or GED equivalent Verbal and Written Skills Required to Perform the Job: Good oral and written communication skills Provides positive customer service skills Must possess the ability to communicate effectively in English; both verbally and in all written communication Technical Knowledge and Skills Required to Perform the Job: Experience in billing, CPT codes, and ICD-10, as well as medical terminology Must be able to work independently Experience and knowledge with Microsoft Office software Math ability to calculate and accurately analyze various accounts Equipment Used: General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc. Working Conditions and Physical Requirements: Sedentary work requires sitting and use of the PC most of the day Universal Requirements: Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment. About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws. Other details Pay Type Hourly Min Hiring Rate $25.03 Max Hiring Rate $32.42 Apply Now
Created: 2024-09-15