Reimbursement Specialist, Day Shift
3 weeks ago
As a Reimbursement Specialist, you will,
•Establishes the payment status of billed or partially paid claims.
•Determines the root cause of denial or partially paid claim.
•Contact the payer either by phone call or online payer portal to determine if the payer is requesting additional information to adjudicate the claim.
•Obtain payment or commitment from payer to pay.
•Obtains status on billed, resubmitted, appealed, and reconsideration claims.
•Determines if the claim is on file.
•Files appeal after review of a denial indicates an appeal is needed or the payer agrees to reprocess the claim.
•Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contact the 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 a 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 the patient once patient responsibility has been determined.
• Review the 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 an insurance company, public health setting, or an outsourcing company.
Work Schedule:
Day Shift (Hybrid) Monday - Friday, 8:30 am - 5:00 pm.
#GR8 Accounting & Finance
At Adventist HealthCare our job is to care for you.
We do this by offering:
Work life balance through nonrotating shiftsRecognition and rewards for professional expertise403(b) retirement planFree Employee parkingBenefits Eligible Positions:
Competitive, comprehensive benefit plans [including health, employer-paid disability and life insurance, PTO]Employer retirement contribution and match after 1-year of eligible employment with 3 year vestingAncillary benefits such as flexible spending, legal and pet insurance to meet the needs of employees and their eligible family membersSubsidized childcare at participating childcare centers
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.
Join the Adventist HealthCare team today, apply now to be considered
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.
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