Reimbursement Specialist (Hybrid), Day Shift, Patient Financial Services

Adventist HealthCare; Buffalo (NY); Hybrid; USD 43,000 - 57,000; Full time

Benefits offered by this job

Free employee parking

Medical, Prescription, Dental, Vision

Short & Long-Term Disability

Basic Life Insurance & AD&D

Paid Time Off

Retirement match

Flexible spending accounts

Tuition Reimbursement

Employee Assistance Program

Job summary

Adventist HealthCare is seeking a Reimbursement Specialist to ensure high-quality patient service, resolve payment issues with payers, and support a hybrid day shift schedule. The role requires healthcare experience and strong problem-solving abilities.

The team focuses on accurate COB verification, denial management, and timely communication with management and patients. The position offers a comprehensive benefits package in a healthcare setting, with opportunities to contribute to process

Qualifications

• 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.

Responsibilities

• Provide excellent patient service and assist in problem resolution for internal and external customers.
• Maintain world-class customer service and telephone etiquette.
• Assist with training of new team members and support management with issue escalation.
• Identify root causes of denials and coordinate with payers for adjudication and rebill as needed.
• Establish payment status and coordinate with patients and payers to resolve balances.

Skills

Customer service

Problem solving

Communication

Teamwork

Education

High School Diploma

Job description

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)

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 and 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

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.

Adventist HealthCare, based in Gaithersburg, MD., is a faith-based, not-for-profit organization of dedicated professionals who work together each day to improve the health and well-being of people and communities through a ministry of physical, mental and spiritual healing.

Our comprehensive approach to caring for our community includes three acute-care hospitals – Shady Grove Medical Center, White Oak Medical Center and Fort Washington Medical Center – as well as two Physical Rehabilitation hospitals, Outpatient centers, Imaging Centers, Urgent Cares, Home Care Services, Employer Health Programs and Physician Networks.

We are nationally recognized and honored especially for our Cardiac, OB, Cancer, Stroke, Orthopedic, Rehabilitation and Mental Health services.

Consider joining our team of over 6,000 employees and become part of one of the longest serving healthcare systems in the Washington, D.C., area that has a long-standing tradition as the largest provider of charity care and community benefit in Montgomery County.

Notice of E-Verify Participation

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.). Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.