Reimbursement Specialist II

Alternate Solutions Health Network, LLC; Ohio; Hybrid; USD 40,000 - 60,000; Full time

Job summary

Alternate Solutions Health Network, LLC in Kettering, OH is seeking a Reimbursement Specialist to manage collections for assigned payors, verify eligibility, and ensure timely claim processing. The role supports patient satisfaction and quality outcomes while complying with Medicaid, private insurance rules and company policies.

Responsibilities include following up on accounts, resubmitting claims, advising on denial trends, assisting families with billing procedures, correcting and rebilling

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.

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

Skills

Billing experience

Healthcare experience

Communication skills

Office software

Detail oriented

Education

High school diploma or equivalent

Associate degree or equivalent experience

Tools

Microsoft Excel

Microsoft Word

Microsoft 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. 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.