Reimbursement Specialist- Comm/Mgd Care- Onsite

Bronson Health; Schoolcraft Township (MI); On-site; USD 48,000 - 64,000; Full time

Job summary

Bronson Healthcare is seeking a Reimbursement Specialist to facilitate third-party payer payments, ensure accurate coding, and maximize reimbursements. The role requires strong billing knowledge, familiarity with Epic applications, and the ability to navigate multiple payer systems.

Responsibilities include posting payments, auditing codes (CPT-4, ICD-10, UB04, HCFA 1500), and resolving issues to improve cash flow while complying with HIPAA and current contracts for several entities.

Qualifications

• High school diploma or GED (required).
• Associate's degree in business or Finance; or equivalent experience in Medical Billing, Receivables or Collection preferred.
• Pass EUPA's for all Epic applications within 90 days.

Responsibilities

• Process and post third party payments to maximize reimbursement.
• Ensure claims comply with payer specifications and HIPAA regulations.
• Analyze CPT-4, ICD-10, UB04, HCFA-1500 codes for accuracy and reimbursement.
• Resolves billing issues to reduce outstanding revenue and rejection time.
• Maintain knowledge of current contracts and government regulations for multiple entities.

Skills

Medical Billing

ICD-10 coding

CPT-4 coding

Typing 45 wpm

Communication skills

Regulatory compliance

Epic software

STAR

EC2000

SSI

GLMI Home Health Billing

Education

GED or Associate in Business/Finance

Tools

Epic

STAR

EC2000

EPIC

SSI

GLMI Home Health Billing system

Job description

Title

Reimbursement Specialist- Comm/Mgd Care- Onsite

Location

Portage-6901 Portage Rd. - Business Office Building

Performs duties necessary to facilitate payment from third party payers. This includes correct billing, statusing and collection from third parties, posting third party payments (if applicable), computing correct reimbursement, processing incoming and outgoing correspondence, and maintaining a working knowledge of current contracts and government regulations for multiple entities. Employees providing direct patient care must demonstrate competencies specific to the population served.

Job Requirements

High school diploma or general education degree (GED) required. Associate's degree in business or Finance; or equivalent experience in Medical Billing, Receivables or Collection preferred. Successfully pass EUPA's for all Epic applications associated with position within the first 90 days in the position.

Responsibilities

• Strong computer and general office equipment knowledge required.
• Knowledge of medical terminology, ICD-10 and CPT-4 coding, National Billing forms, third-party payers, managed care, reimbursement and regulatory compliance preferred.
• Ability to type 45 words per minute is necessary.
• Must be an effective communicator with patients, customers and co-workers.
• Must be able to quickly analyze communication style based on nature and approach of verbal inquiry.
• Accountable for ensuring claims are compliant with all payer specifications; State, Federal and HIPAA regulations.
• Resolves billing issues up front to promote better reimbursement, reduce outstanding revenue and time spent on working rejections or additional claim follow up.
• Prepares documentation to maximize reimbursement.
• Analyze assignment of all CPT-4, ICD-10, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third party payers.
• Critically analyze and process third party and internal information requests and rejections in an effort to resolve accounts receivable.
• Critically analyze and process documents for resolution of third party liabilities, outstanding credits and un-billed accounts.
• Make all necessary posting, adjustments and refunds to accounts and critique contractual allowances and other arrangements.
• Responsible for complete understanding and application of current contracts and governmental regulations including referrals for legal intervention for multiple entities.
• Proficient in the revenue cycle process via multiple computer systems including but not limited to: Internal systems: STAR, EC2000, EPIC, SSI, GLMI Home Health Billing system and External systems such as payer claims and eligibility systems.
• Verifies insurance eligibility using automated on-line systems.

Physical Demands

Work which produces very high levels of mental/visual fatigue, e.g. CRT work between 70 and 90 percent of the time, and work involving extremely close tolerances and considerable hand/eye coordination for sustained periods of time. The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.

Shift

Shift: First Shift

Time Type

Full time

Scheduled Weekly Hours

40

About Bronson

Bronson Healthcare Group and its affiliates (“Bronson”) strictly prohibit the acceptance of unsolicited resumes from individual recruiters or third-party recruiting agencies ("Recruiters") in response to job postings or word of mouth. Unsolicited resumes sent to any employee of Bronson by Recruiters, without both a valid written agreement with Bronson and a direct written request from the Bronson Talent Acquisition Department for a specific job position, will be considered the property of Bronson. Furthermore, no fees will be owed or paid to Recruiters who submit resumes for unsolicited candidates, even if those candidates are hired. This policy applies regardless of whether the Recruiter has a pre-existing agreement with Bronson. Only candidates submitted through a specific written agreement with the Bronson Talent Acquisition Department for a named position are eligible for fee consideration. Bronson Healthcare is a community-owned, not-for-profit health system that has been serving southwest Michigan since 1900. Today, with a workforce of 9,000 people and 1,500 medical staff members, it is the area’s largest employer and leading healthcare system. Bronson provides care in virtually every specialty and offers a full range of services from primary care to critical care at more than 100 locations. Bronson’s exceptionally high quality standards enable us to do what’s right for our patients and their families. We are empowered as individuals and as teams, to apply our skills and experience so that every patient receives safe, timely and effective treatment. What’s more, our state‑of‑the‑art, technology and evidence‑based processes give us the tools we need to deliver the right care, at the right time. By putting each patient and their family at the center of our work, we demonstrate the dignity and respect we have for each individual we serve. This unwavering commitment to serving others combined with our unique healing environment helps make the patient experience here an exceptional one. The excellence and Positivity of our employees and medical staff has contributed to Bronson Healthcare being ranked by Forbes as one of America’s Best‑In‑State Employers (2022-23), by Newsweek as one of America’s Greatest Workplaces for Women (2023) and by the National Association for Business Resources as one of the 2023 Top 101 Best and Brightest Companies to Work For.