Insurance and Government Reimbursement Specialist

Schedule: 8am to 4:30 pm Monday - Friday At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities. A Brief Overview Collects outstanding insurance and government payor accounts and unpaid balances via telephone, email, and mail. Verifies the accuracy of all insurance and government payor payments, rebills underpayments, appeals denials and turns them into payments, and ensures accurate payor and government reimbursement on all claims. Essential Functions

• Follows up on outstanding insurance and government payor claims and charges in follow-up work queues and on various reports by contacting insurance or government carriers and patients for status including processing correspondence.
• Rebills underpayments, appeals denials and turns them into payments, ensures accurate reimbursement from insurance and government payors on all claims.
• Audits accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports and work queues to do so.
• Reviews all secondary claims prior to submission to ensure accuracy of claim and COB registration information. If prior insurance pays more than Medicaid allowable when Medicaid is secondary, handles adjustments according to department procedures.
• Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
• Completes all requests and follow ups with medical records, pharmacy, etc. in order to ensure payments from third party payors.
• Refers adjustments to reverse any discounts/contractual posted incorrectly, per department procedures
• Keeps current on payor requirements though workshops, newsletters, and websites.
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or GED equivalent Required and
• Associate's Degree in Billing, Coding, Business, Finance, or related filed Preferred

Experience Qualifications

• Minimum 2 years of experience working with commercial or government billing and reimbursement processes or Associate’s degree in Billing, Coding or HIM Required

Skills and Abilities

• Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
• Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.
• Ability to review, interpret and understand managed care contracts and EOB’s with third-party payers to ensure appropriate reimbursement.
• Intermediate computer skills including the use of spreadsheet programs and word processing programs.
• Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.
• Excellent oral and written communication skills as this position will deal directly with the public daily.
• Ability to perform non-complex arithmetic calculations

Licenses and Certifications

• EPIC - EPIC Certification Preferred

Children’s is the very best for kids and the very best for your career! At Children’s, we put YOU first so together, we can improve the life of every child!