Reimbursement Specialist

6 days ago


Gaithersburg, Maryland, United States Adventist HealthCare Full time
Reimbursement Specialist Job Summary

Adventist HealthCare is seeking an experienced Reimbursement Specialist to join our Patient Financial Services Department. As a Reimbursement Specialist, you will play a critical role in ensuring timely and accurate payment of patient claims.

Key Responsibilities:
  • Establish payment status of billed or partially paid claims
  • Determine root cause of denial or partially paid claim
  • Contact payer to determine additional information needed for adjudication
  • Obtain payment or commitment from payer
  • Obtain status on billed, resubmitted, appealed, and reconsideration claims
  • Determine if claim is on file
  • File appeal after review of denial indicates appeal is needed
  • Request rebill/corrections if denial has been reviewed
  • Contact payer if denial was inappropriate or additional information is needed
  • Route denial to appropriate team
  • Route claim to biller when no claim is on file
  • Transfer unpaid balance to patient
  • Review Explanation of Benefits for clarity
  • Process payer changes as needed
Qualifications:
  • High School Diploma required, or some college preferred
  • Minimum of 3 years' experience in healthcare environment
Work Schedule:

Day Shift (Hybrid) Monday - Friday, 8:30 am - 5:00 pm

Adventist HealthCare offers a competitive benefits package, including health, disability, and life insurance, as well as a 403(b) retirement plan. We also offer flexible spending, legal, and pet insurance to meet the needs of employees and their eligible family members.

As a faith-based organization, Adventist HealthCare has a reputation for high-quality, compassionate care. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture.

Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We welcome applicants from diverse backgrounds and are committed to creating a welcoming, equitable, and safe place to work and grow for all employees.



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