Reimbursement Specialist

Sarasota Memorial Health Care System; Sarasota (FL); On-site; USD 52,000 - 82,000; Full time

Job summary

Sarasota Memorial Health Care System is seeking a Reimbursement Specialist to ensure accurate and timely posting of charges across departments including Surgery, ER, Observation, and Delivery/High Risk areas. You will review records to support charge accuracy and resolve CCI edits under Revenue Cycle Management oversight.

The role requires at least two years in healthcare charging or a current coding certification; preferred candidates may hold coding or clinical certifications.

Qualifications

• Require a minimum of two (2) years of health care experience involving charging practices and patient flow processes.
• Current coding certification will substitute for the required experience.

Responsibilities

• Post charges accurately and timely for Surgery, Emergency Room (ECC) charges for SMH or North Port, hospital wide observation charges, and Delivery/High Risk Antepartum/Testing/Triage charges.
• Review medical records to verify documentation supports charge accuracy and assists in resolving CCI edits.
• Mentor and train other Reimbursement Specialists in charging practices and billing compliance.

Job description

Department

Revenue Cycle

Job Summary

Provides administrative support responsible for accurate and timely posting of Surgery, Emergency Room (ECC) charges for either SMH or North Port, hospital wide observation charges, or Delivery/High Risk Antepartum/Testing/Triage charges, under the direction and supervision of the Revenue Cycle Management. Provides compliant charging practices for all payors by reviewing the medical record for appropriate clinical documentation that supports the accuracy of charges. Assists in the review and resolution of Surgery, Emergency Room, Observation, or Delivery/ High Risk Antepartum/Testing/Triage charge Correct Coding Initiative (CCI) edits. Acts as a mentor and trainer to other Reimbursement Specialists.

Required Qualifications

• Require a minimum of two (2) years of health care experience involving charging practices and patient flow processes. Current coding certification will substitute for the required experience.

Preferred Qualifications

• Prefer coding certification.
• Prefer clinical certification from a recognized health care credentialing organization in a specialty area (i.e., RRA, RT, VI, CI, RCIS, RVS, CSFA, and CST).
• Prefer demonstrated interpersonal and communication skills.
• Require a working knowledge of commonly used computer applications.
• Prefer the ability to work with minimal supervision.
• Prefer demonstrated proficiency with medical terminology.
• Prefer demonstrated proficiency with specific charging and coding as it applies to various departments (i.e. Surgery, Emergency Room, Observation, or Delivery/High Risk Antepartum/Testing/Triage.

Mandatory Education

HS EQ: High School Diploma, GED or Certificate

Additional Details

Four to five days a week.

Employment Screening Requirements

As part of Sarasota Memorial Health Care System’s commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/

• Prefer coding certification.
• Prefer clinical certification from a recognized health care credentialing organization in a specialty area (i.e., RRA, RT, VI, CI, RCIS, RVS, CSFA, and CST).
• Prefer demonstrated interpersonal and communication skills.
• Require a working knowledge of commonly used computer applications.
• Prefer the ability to work with minimal supervision.
• Prefer demonstrated proficiency with medical terminology.
• Prefer demonstrated proficiency with specific charging and coding as it applies to various departments (i.e. Surgery, Emergency Room, Observation, or Delivery/High Risk Antepartum/Testing/Triage.

• Require a minimum of two (2) years of health care experience involving charging practices and patient flow processes. Current coding certification will substitute for the required experience.