Reimbursement Specialist

The Reimbursement Specialist - Cash Applications will play a critical role in ensuring the timely and accurate processing of cash transactions, denials, and adjustments in accordance with Pentec Health's compliance program.

• Cash Posting: Accurately post cash receipts, denials, and adjustments from 3rd party remittances and Explanations of Benefits (EOB) to the appropriate patient invoices.
• Organize and prepare lockbox deposits for cash posting and distribution to the appropriate team on a daily basis.
• Determine if credit balances are duplicate or overpayments that must be adjusted and/or transferred to a liability account and subsequently refunded to the payer or patient.
• Contact insurance payers for missing remittances when necessary.
• Utilize all available reports to reconcile cash receipts posted to cash reported on deposit by the banking institution on a daily basis and/or per batch, as outlined and established by policy.
• Generate and review reporting to ensure transactions are properly posted, correcting any errors or misstatements as needed.
• Use discretion and experience to identify and communicate any discrepancies to the attention of the Supervisor.
• Post insurance carrier take-back/recoupment and track subsequent utilization based on review of reimbursements EOB and comparison against known outstanding liabilities.
• Accurately and concisely document accounts so that information can be readily understood by others throughout the company.

The Reimbursement Specialist - Cash Applications will be involved in a variety of projects and audits as outlined by leadership, including but not limited to:

• Pricing analysis
• Payer audits
• Assessment of credit balances for refund or revenue adjustment
• Payment analysis of HCPCS coding for non-contracted payers
• Cash trends
• DSO reporting

The ideal candidate will have:

• Associates degree, some college coursework, and/or a combination of education and experience.
• Minimum of 2 years hands-on experience in a billing, collections, or cash posting role within a physician office, specialty infusion, home care, or related field.
• Proficiency in CPR+ or similar platform.
• Experience with MS Office, especially Word, Excel, and PowerPoint, with a focus on creating and developing spreadsheets, presentations, and reports effectively and efficiently.
• Demonstrated ability to review remittance from a variety of payers, investigate issues with invoices, and confer with internal and external parties to resolve discrepancies.
• Ability to calculate figures and amounts correctly, such as interest and percentages, and reconciling cash posted to cash received.
• Basic understanding of 3rd party Reimbursement processes.
• Clear and effective communication of the American English language via face-to-face, telephone, and written communication.

The ideal candidate will have the ability to:

• Anticipate issues, research, and implement creative solutions.
• Work independently and as part of a team environment.
• Be a self-starter with the ability to work with little to no direct supervision.
• Be dependable and adhere to deadlines.
• Have strong organizational and problem-solving skills, including being solutions-oriented and able to communicate a sense of authority through subject matter expertise and resourcefulness.

The salary range for this position is $45,000 annually, with a comprehensive compensation and full benefits package offered by Pentec Health.