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Claims Processing Specialist

2 months ago

Harlingen, Texas, United States Prime Healthcare Full time
About Prime Healthcare

Prime Healthcare is a prestigious healthcare organization based in Ontario, California. With a network of 45 hospitals and over 300 outpatient facilities across 14 states, we facilitate more than 2.6 million patient visits each year.

As one of the foremost health systems in the nation, we employ nearly 50,000 dedicated professionals, including physicians. Fourteen of our hospitals are affiliated with the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity.

Prime Healthcare is committed to fostering a diverse workforce and is an equal opportunity employer. We strictly prohibit discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (where applicable), disability, military status, genetic information, or any other protected category under federal, state, or local laws. Harassment based on these protected characteristics is also not tolerated.


Position Overview

We are currently seeking a Reimbursement Specialist to join our corporate team. This role, reporting to the PFS Director, is crucial for ensuring accurate and timely analysis of managed care contracts to verify that appropriate reimbursements are received.

The Reimbursement Specialist will:

  • Utilize complex regulations, guidelines, and systems to analyze payments from insurance providers, ensuring maximum and accurate reimbursement.
  • Proactively collaborate with payers and internal resources to identify and resolve issues that may impede optimal account payments.
  • Apply relevant regulations to ensure compliance with payment practices.

Qualifications

To be considered for this role, candidates should possess:

  • A minimum of four years of experience in hospital billing and collections.
  • Strong knowledge of medical and insurance terminology.
  • Familiarity with CPT, ICD-9, and HCPCS coding structures.
  • Experience in payment and Explanation of Benefits (EOB) review.