Reimbursement Specialist, Day Shift, Patient Financial Services

Adventist HealthCare; Gaithersburg (MD); Hybrid; USD 43,000 - 57,000; Full time

Benefits offered by this job

Parking

Health insurance

Paid time off

Employer retirement plan

Tuition reimbursement

Job summary

Adventist HealthCare seeks an experienced Reimbursement Specialist for our Patient Financial Services Department. The role focuses on resolving payer issues, verifying benefits, and ensuring accurate billing and collections in a hybrid, full-time setting in Gaithersburg, MD.

You will work to identify root causes of denials, communicate with payers, and support team members with training and process improvements. A minimum of 3 years in healthcare billing is preferred.

Qualifications

• High School Diploma required, or some college preferred.

Responsibilities

• Demonstrates excellent patient service skills, assists in problem resolution both internal and external.
• Follows up on billed and/or denied accounts with third party payers.
• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of denial or partially paid claim.
• Contacts payer by phone or online payer portal to determine if additional information is needed to adjudicate claim.

Education

High School Diploma or some college

Job description

Adventist HealthCare seeks to hire an experienced Reimbursement Specialist for our Patient Financial Services Department who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing.

As a Reimbursement Specialist, you will:

• Demonstrates excellent patient service skills, assists in problem resolution both internal and external.
• Demonstrates world class exceptional customer service and set example of correct phone etiquette.
• Promote teamwork and a positive work environment.
• Communicates to management when issues arise.
• Demonstrates an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management.
• Assist with training of new team members.
• Independently problem solves and identifies opportunities for improvement.
• Completes tasks assigned in a timely and efficient manner in accordance with department policy.
• Follows up on billed and/or denied accounts with third party payers.
• Demonstrates ability to troubleshoot and elevate appropriate issues to management.
• Raises awareness of payer related trends to management with supporting data.
• Submits adjustment requests for services deemed uncollectable.
• Verifies Coordination of Benefits for all insurance provided.
• Demonstrates excellent customer service skills, assists in problem resolution both internal and external.
• Other duties as assigned.
• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of denial or partially paid claim.
• Contacts payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
• Obtain payment or commitment from payer to pay.
• Obtains status on billed, resubmitted, appealed and reconsideration claims.
• Determines if claim is on file.
• Files appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
• Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contacts payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
• Routes denial to the appropriate team after denial has been determined that another department should resolve.
• Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers unpaid balance to patient once patient responsibility has been determined.
• Reviews Explanation of Benefits for clarity.
• Processes payer changes as needed.

Qualifications include:

• High School Diploma required, or some college preferred.
• A minimum of 3 years’ experience within a healthcare environment can include insurance company, public health setting or an outsourcing company.
• Frequent pressure due to time constraints
• Frequently works at PC involving focused concentration.
• Frequent walking, standing, bending, kneeling/crouching, sitting etc.
• Light physical effort (lifts or carries up to 10lbs)
• Atmosphere and environment associated with an office setting.
• Must maintain a professional appearance and demeanor at all times

Work Schedule

Employment Type: Full-time

Hours per Week: 40 hours/week

Typical Daily Schedule: 8 am- 5 pm Monday through Friday

Shift Type: Day Shift-Hybrid Schedule

Holiday Requirements: Follow company holiday calendar

Pay Range: $20.51 - $27.21

If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.

Under the Fair Labor Standards Act (FLSA), this position is classified as:

United States of America (Non-Exempt)

Benefits

At Adventist HealthCare our job is to care for you. We do this by offering:

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance & AD&D, short-term disability buy-up available
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County. If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.

COVID-19 Vaccination Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.

Tobacco and Drug Statement Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use. While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result. Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow‑up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).)

Equal Employment Opportunity Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission‑centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law. Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants’ religious beliefs. Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.

Our Mission: We extend God's care through the ministry of physical, mental and spiritual healing.

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