The Reimbursement Specialist compiles, reviews, and processes billing and accounts receivable documents, insurance bills and payments, and prepares and maintains all accounts receivable and patient service revenue records and reports.

Primary Tasks, Duties and Responsibilities:

1. Promotes and practices the hospice mission and values and follows all policies and procedures.
2. Prepares, reviews, and submits monthly billings according to established procedures. Matches bills with census and identifies discrepancies; reviews patient billing revenues for accuracy.
3. Records all payments as received, performs monthly reconciliation of cash receipts; and maintains accounts receivable records and reports.
4. Reviews and corrects accounts receivable bills/records before transmission or mailing.
5. Continuously works on clearing rejections, denials and returned claims, performing all necessary follow-up to ensure collection of payments from Medicare/Medicaid and Insurance providers.
6. Completes billing audits to ensure accuracy and/or compliance.
7. Receives and answers inquiries from insurance sources/Case Managers regarding patient status or obtaining updated authorizations.
8. Consults with appropriate departments and personnel regarding status of patients for billing purposes.
9. Contacts Medical Records as needed to acquire any information and records needed for billing.
10. Coordinates the compilation and submission of information needed for Medicaid and Medicaid managed care providers, including obtaining authorizations.
11. Coordinates with Long Term Care (LTC) facilities relating to patient responsibility and notification of Tidewell Hospice (or affiliate) Admission.
12. Continuously strives to improve processes and maintain high standards of quality and customer service.

Secondary Responsibilities:

Every incidental duty connected with the Reimbursement Specialist position cannot be specified in the job description and the colleague, at the discretion of the Accounts Receivable Manager, may be required to perform duties that are not included in this job description.

Educational/Professional:

1. Associates Degree with one year previous billing/medical office related experience preferred.
2. Bookkeeping or billing certification courses preferred.
3. An equivalent combination of professional experience and education may be considered as meeting the Education / Professional requirements.

Knowledge, Skills and Abilities Required:

1. Demonstrated experience in general healthcare billing practices; proficiency with billing software and Netsmart EMR within 3 months of post-hire.
2. Accurately perform mathematical computations and audit data to detect errors.
3. Ability to work well within a team environment and manage assigned tasks with limited supervisory support.
4. Strong interpersonal, communication and customer service skills.
5. Knowledge of Medicare/Medicaid billing regulations.
6. Knowledge and familiarity with medical terminology.
7. Strong PC skills, including proficiency in Microsoft Office Suite, database applications and medical billing applications.
8. Ability to keyboard 30 wpm.

Empath Health values diversity as it strengthens our community and care. We embrace the diversity of cultures, thoughts, beliefs and traditions of our employees, volunteers and people we are honored to serve across our network. Our diverse staff reflects our community and each day, we work to be respectful, sensitive and competent with each other and those in our care. In every journey, we are dedicated to achieving comfort, dignity and exceptional care. Those of all backgrounds are welcome and encouraged to apply with us or seek our care and services.

Our commitment to patient, client, staff and volunteer safety is a cornerstone of a High Reliability Organization with a focus on zero harm. Participation in the seasonal influenza program is a condition of employment and a requirement for all Empath Health employees.

Providing compassionate, full life care is an honor we take seriously at Empath Health. Join our team and make a positive impact in the community!