HOSPITAL PAYMENT REVIEWER

LevelUP HCS; New York (NY); On-site; USD 53,000 - 80,000; Full time

Job summary

A leading company is seeking a Hospital Payment Reviewer to ensure appropriate reimbursement for third-party accounts. The role includes reviewing contracts and remittance advice, resolving discrepancies, and adhering to performance standards. Ideal candidates will have previous hospital experience and clerical skills, with a strong focus on account management and insurance processes.

Qualifications

• Clerical experience required.
• Ability to use basic office equipment.
• Previous hospital experience preferred.

Responsibilities

• Reviews all remittance advice for appropriate reimbursement.
• Takes necessary action to resolve account variances.
• Contacts insurance carriers for payment and credit resolution.

Skills

Clerical experience

Medical terminology

Education

High School Graduate or GED

HBI certification

Job description

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Base pay range

$53,840.00/yr - $80,000.00/yr

Direct message the job poster from LevelUP HCS

Our client is looking for a HOSPITAL PAYMENT REVIEWER- Hospital experience required

Salary Range: $53,840- $80,782

Position Summary

Reviews all remittance advice to ensure appropriate reimbursement for 3rd party accounts billed. Reviews HMO/Insurance contract matrix and HIS expected reimbursement amounts to ensure reimbursement is appropriate. Takes necessary action to resolve account variances and ensure adherence to contract terms.

Essential Functions and Responsibilities Includes the Following:

1. Understands and adheres to the Performance Standards, Policies and Behaviors

2. Reviews third-party remittance advice to ensure proper payment was received from insurance carrier based on contract arrangement

3. Reviews HIS to ensure expected reimbursement amount is amount received by insurance carrier

4. Takes necessary action on any reimbursement discrepancies to ensure payments adhere to contract rates and terms

5. Research and initiate refunds to patients or insurance carriers as needed

6. Sends inquiries to patients regarding inaccurate or incomplete information

7. Escalates issues to management and provider representatives regarding incorrect payer processing and/or contract issues

8. Completes charge adjustments and allowances entries on accounts as needed

9. Recodes accounts by insurance carrier and plan number and enters into the HIS for rebilling purposes

10. Processes rejections on accounts denied by insurance carriers

11. Assists with telephone calls as needed

12. Contacts insurance carriers as needed for additional payment and or credit resolution

13. Performs all other related duties as assigned

14. HBI certification certificate required prior to end of probationary period

Education & Experience Requirements

High School Graduate or GED required

Clerical experience required

Previous hospital experience preferred

Ability to use basic office equipment and knowledge of CTR computer terminals a plus

Medical terminology helpful but not mandatory

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative

• Industries

  Hospitals and Health Care

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