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Reimbursement Specialist
Reimbursement SpecialistAllegiance Health Management, Inc. • Bossier City, LA, US
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Reimbursement Specialist

Reimbursement Specialist

Allegiance Health Management, Inc. • Bossier City, LA, US
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Job Description

Job Description

POSITION SUMMARY :

Under the supervision of the Corporate Director of Insurance Contracts / Charge Master Analyst the Reimbursement Specialist responsibilities include :

  • Maintaining and updating the Chargemaster to comply with federal and state regulations and internal hospital policies. Coordinate with Department Managers and / or Practice Mangers to assure all necessary charges are built in the Chargemaster and perform audits to evaluate if all charges are being captured.
  • Responsible as the managed care subject matter expert. Investigates and resolves managed care reimbursement issues identified by the facilities or payers, including fee schedule and reimbursement loading of contracts accuracy in system. Maintains payer summary matrix. Analyzes contractual payments for opportunities. Coordinate and communicate contractual terms to the billing and collection departments; ensure staff is informed of changes in medical policy & billing policies.

QUALIFICATIONS :

  • High-school diploma or GED required. Associate degree in related field preferred.
  • Two years recent experience in the healthcare industry, i.e. performing CDM-related tasks, Certified Professional Coder (CPC), or other revenue cycle functions.
  • Excellent Microsoft Excel skills

    • NOTE : Candidate MUST reside in the state of Louisiana and be able to travel to the nearest CBO location for training and other necessary requirements.

    SKILLS PREFERRED :

  • Interpersonal skills to work with end users.
  • Experience with HIPAA and other Healthcare standards a plus.
  • Excellent oral and written communication skills - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Participates in meetings. Writes clearly and informatively; edits work for spelling and grammar; able to read and interpret written information.
  • Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Supports everyone's efforts to succeed.
  • Ethics - Treats people with respect; Keeps commitments; Works with integrity and ethically; Upholds organizational values.
  • Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values; Supports affirmative action and respects diversity.
  • Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
  • Planning / Organizing - Prioritizes and plans work activities; Uses time efficiently.
  • Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
  • Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
  • Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

    • Basic computer skills required.

    PHYSICAL AND MENTAL REQUIREMENTS :

    Physical : Walking - up to 50% Standing - up to 40% Kneeling - up to 1%

    Sitting - up to 50% Pushing - up to 5% Bending - up to 5%

    Squatting - up to 5% Pulling - up to 5% Reaching - up to 10%

    Lifting - up to 25lbs. Wrist / Finger Movements - up to 80%

    Mental : Stress Level : Moderate to High

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