San Ysidro Health
Reimbursement Specialist I (Hybrid)
San Ysidro Health, San Diego, California, United States, 92101
Reimbursement Specialist I
Position Summary: The Reimbursement Specialist I is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims. They are responsible for the follow-up performed on insurance balances to ensure reimbursement is accurate and received timely. They are also responsible for the self-pay collections after insurance. Essential Functions of the Job: Prepares accounts and encounters for accuracy for billing. Prepare, review, and transmit claims using automated systems and manual paper claim process. Provides any required attachments to third party claims including authorizations and EOB'S to ensure timely payment for the third party payer. Changes system financial settings once primary insurance has paid to insure that co-payments and deductibles are generated to guarantors. Identify and bill secondary payers. Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates. Performs adjustment write off(s) keying and posting via computer input after obtaining approval signatures if required. Performs timely follow up and appeals on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents. Documents all analysis findings, phone calls and correspondence in the online practice management system. Respond to all patient or insurance telephone inquiries to ensure timely reimbursement. Must maintain assigned Accounts Receivable at or below goal on a consistent basis. The Reimbursement Specialist is required to compose professional written correspondence with all internal & external entities. Attends meeting and training classes as required by departmental or facility management. Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours. Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety and infection control standards. Additional Duties and Responsibilities: Performs other duties as assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors. Job Requirements: Experience Required: Minimum of 1 years' experience in a medical billing department. Must also demonstrated knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology. Education Required: High School Diploma or GED equivalent Verbal and Written Skills Required to Perform the Job: Good oral and written communication skills. Provides positive customer service skills. Must possess the ability to communicate effectively in English; both verbally and in all written communication. Technical Knowledge and Skills Required to Perform the Job: Experience in billing, CPT codes, and ICD-10, as well as medical terminology. Must be able to work independently. Experience and knowledge with Microsoft Office software. Math ability to calculate and accurately analyze various accounts. Equipment Used: General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc. Working Conditions and Physical Requirements: Sedentary work requires sitting and use of the PC most of the day. Universal Requirements: Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
Position Summary: The Reimbursement Specialist I is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims. They are responsible for the follow-up performed on insurance balances to ensure reimbursement is accurate and received timely. They are also responsible for the self-pay collections after insurance. Essential Functions of the Job: Prepares accounts and encounters for accuracy for billing. Prepare, review, and transmit claims using automated systems and manual paper claim process. Provides any required attachments to third party claims including authorizations and EOB'S to ensure timely payment for the third party payer. Changes system financial settings once primary insurance has paid to insure that co-payments and deductibles are generated to guarantors. Identify and bill secondary payers. Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates. Performs adjustment write off(s) keying and posting via computer input after obtaining approval signatures if required. Performs timely follow up and appeals on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents. Documents all analysis findings, phone calls and correspondence in the online practice management system. Respond to all patient or insurance telephone inquiries to ensure timely reimbursement. Must maintain assigned Accounts Receivable at or below goal on a consistent basis. The Reimbursement Specialist is required to compose professional written correspondence with all internal & external entities. Attends meeting and training classes as required by departmental or facility management. Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours. Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety and infection control standards. Additional Duties and Responsibilities: Performs other duties as assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors. Job Requirements: Experience Required: Minimum of 1 years' experience in a medical billing department. Must also demonstrated knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology. Education Required: High School Diploma or GED equivalent Verbal and Written Skills Required to Perform the Job: Good oral and written communication skills. Provides positive customer service skills. Must possess the ability to communicate effectively in English; both verbally and in all written communication. Technical Knowledge and Skills Required to Perform the Job: Experience in billing, CPT codes, and ICD-10, as well as medical terminology. Must be able to work independently. Experience and knowledge with Microsoft Office software. Math ability to calculate and accurately analyze various accounts. Equipment Used: General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc. Working Conditions and Physical Requirements: Sedentary work requires sitting and use of the PC most of the day. Universal Requirements: Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.