Reimbursement Specialist II

Alternate Solutions Health Network, LLC; Kettering (OH); On-site; USD 45,000 - 60,000; Full time

Job summary

Alternate Solutions Health Network, LLC in Kettering, OH is hiring a Reimbursement Specialist to manage all collection aspects for assigned payors and verify eligibility. The role ensures prompt payments and accurate claim processing, impacting patient satisfaction and outcomes.

The position requires a high school diploma or equivalent with an Associate’s degree preferred, billing/healthcare experience, and strong MS Office skills. Office-based with a hybrid model available based on productivity.

Qualifications

• High school diploma or equivalent.
• Associate’s degree preferred or equivalent experience.
• Billing and Health Care experience is required.
• Excellent oral and written communication skills.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Detail oriented with ability to manage multiple responsibilities and prioritize tasks.

Responsibilities

• Collects and follows up on accounts for payment in full.
• Sends all electronic and paper claim resubmissions or correct claims.
• Makes recommendations regarding payors for prompt payments and denial trends.
• Assists clients, their families and co-workers in understanding billing procedures.
• Corrects claims and rebills for payment.
• Communicates with employees, clients and vendors about services.
• Proactively addresses billing challenges.
• Follows agency policies and regulations.
• Attends in-services and meetings as necessary.

Skills

Billing

Healthcare

Communication

MS Office

Prioritization

Education

High school diploma

Associate's degree

Tools

Microsoft Excel

Word

Outlook

Job description

Our culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.

Schedule: Monday - Friday, 8:15am - 5:00pm in our office in Kettering OH

Location: In-office at our Kettering, OH location | Hybrid Model available based on productivity

The Reimbursement Specialist is responsible for all collection aspects for assigned payors and confirms eligibility for payor types. The Reimbursement Specialist ensures prompt payments and claim processing. Functions of this role performed timely and accurately, affect patient satisfaction, and quality outcomes. The Reimbursement Specialist complies with all legal, Medicaid & private insurance and company rules and regulations.

Responsibilities

• Collects and follows up on accounts for payment in full
• Sends all electronic and paper claim resubmissions or correct claims
• Makes recommendations to the Controller regarding difficult payors with regards to prompt payments, claims processing, and recognition of denial trends.
• Assists clients, their families and co-workers in understanding billing procedures and payment
• Corrects claims and rebills for payment
• Communicates with employees, clients and vendors in regards to services
• Proactively addresses billing challenges
• Understands and practices agency policies and procedures
• Continually improves practices
• Follows all legal rules and regulations
• Attends in-services, educational programs and meetings as necessary
• Other duties as assigned

Qualifications

• High school diploma or equivalent.
• An Associate’s degree or equivalent experience required.
• Billing and Health Care experience is required
• Excellent oral and written communication skills.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Detail oriented with ability to manage multiple responsibilities and ability to prioritize responsibilities. Demonstrate critical thinking and problem solving.

Kettering, OH #INDASHN3

We’ll help you put your passion for patient care to work.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

We are an Equal Opportunity Employer.

ASHN will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact [e-mail] to validate the request Alternate Solutions Health Network collaborates with health systems in joint venture partnerships to create a post-acute care solution to deliver efficient centralized operations that is patient focused. Our company has been dedicated, since the very beginning, to transforming the quality of care for our team and our patients.