Reimbursement Specialist-Onsite

Bronson Healthcare; Kalamazoo (MI); On-site; USD 42,000 - 62,000; Full time

Job summary

Bronson Healthcare Group in Kalamazoo is seeking an onsite Reimbursement Specialist to manage third-party payments, ensure accurate coding and timely reimbursement across multiple entities.

Candidates should have a GED or higher, an associate degree in business/finance (or equivalent experience), and familiarity with Epic, ICD-9, CPT-4, and HIPAA requirements. Strong typing and communication skills are essential.

Qualifications

• GED or high school diploma required; associate degree preferred.
• Associate degree in business or finance or equivalent medical billing experience.
• Experience with Epic applications within 90 days is expected.
• Knowledge of ICD-9, CPT-4, payer regulations and HIPAA compliance is preferred.

Responsibilities

• Ensure claims are compliant with payer specifications and regulations.
• Analyze CPT-4, ICD-9, UB04 data for accuracy and reimbursement.
• Post third party payments and resolve billing issues promptly.
• Maintain knowledge of contracts and government regulations across entities.
• Communicate effectively with patients, payers and co-workers.

Skills

Medical Billing

Communication

Typing 45 WPM

Regulatory Compliance

Third-Party Payers

Education

Associate's degree in business or Finance; or equivalent experience

GED/High School Diploma

Tools

Epic

STAR

EC2000

Job description

Title

Reimbursement Specialist-Onsite

Location

BHG Bronson Healthcare Group

Job Duties

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.

Education & Experience

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.

• Strong computer and general office equipment knowledge required.
• Knowledge of medical terminology, ICD-9 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.

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.

• 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-9, 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.

Shift

First Shift

Time Type

Full time

Scheduled Weekly Hours

40

Cost Center

1203 Call Center/Financial Counselors (BHG)

Agency Use Policy and Agency Submittal Disclaimer

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.