About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

The Reimbursement Specialist is responsible for claim management, denial management and aged unpaid claim follow up. Responsible for processing insurance claims for various types of insurance and maximizing SMGOR reimbursement. Responsible for claim resolution through working claims edits and appealing denied claims in a timely manner. Track status of outstanding claims, follow up on outstanding AR balances and monitoring of payer response. Provide detailed information regarding problem payers to management; provide suggestions for solutions to management.

Essential Job functions:

• Monitoring and working in the work queues for assigned providers and specialties, to include researching and correcting claims, writing appeals and facilitating their submission for appealing adverse decisions, contacting payers as needed, and all other activities that lead to the successful adjudication of eligible claims.
• Any payer specific coding and charge entry based on assigned providers and specialties.
• Completing claims worklists assigned by Reimbursement Supervisor.
• Complete system knowledge to include credit work queues. Have the ability to research and resolve overpayments for insurance and self-pay.
• Responsible for monitoring contractual allowances.
• Reviews and analyzes EOBs for identified under allowed claims.
• Researches and resolves billing errors including resubmission of claims to insurance companies. Make any necessary corrections/refunds.
• Compiles and submits appeals, and monitors for proper reimbursement according to current contract
• Provide CPT and contract analysis reports as requested
• Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties.
• Receive transferred calls or emails from Patient Accounts staff from insurance companies requesting advanced assistance with their patient account.
• Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.
• Perform payment posting and charge entry as needed.

General Job functions:

• Proficient in EMR/EHR.
• Proficient in management and resolution of items in the work queues
  • Rules versus denials
  • Claim edits: what they are and what they do.
  • Claim note history including actions and claim statuses
  • Payer Rejections
  • Utilizing and managing payer websites
  • Sorting in work queue to prioritize daily as assigned

• Proficient in explanation of benefits (EOBs) and electronic remittance advice (ERA) reason and remark codes provided by the payers.
• Proficient in working claim edit work lists
  • Claim attachment
  • Corrected claim attachment
  • Payer specific edit

• Exhibit strong communication skills with internal players including physicians, providers, peers, and your supervisor/manager
• Exhibit strong communication skills in claim notation, appeals and payers.
• Understanding of generally accepted insurance benefit terms and processes
• Understanding of Documents Table, Registration, and Claim Edit screens. All screens, tools and data locations available under the user’s security access.
• Understanding of request/preparation of supporting documentation such as medical records, dictation, appeal letters, contract pages.

• Understanding of patient balance policies, workflows, and tools.
• Understanding of investigation and Denial/Appeal/Preparation of refunds for both the Patient and Insurance.

Physical Job Requirements:

• Dexterity of hands and fingers
• Endurance (e.g. continuous typing, prolonged standing/bending, walking)

Education, Certification, Computer and Training Requirements:

• High School Graduate/GED required. Associate’s degree preferred.
• Two years medical office or billing experience preferred.
• Ability to communicate effectively, both orally and in writing required.
• Strong attention to detail and customer service skills required.
• Strong problem solving and decision making skills required.
• Experience with PM/EMR.
• Experience with Standard Office Technology in a Window based environment; including experience with Microsoft Office, Word and Excel required.
• Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) required.
• Familiar with modifiers, CPT, diagnoses, credentialing process and State and Federal insurance laws.

Travel:

• Travel to Satellite locations for meetings

This is a non-exempt position. The base compensation range for this role is $19.00/hr - $22.00/hr. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan

About Our Commitment

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.