What are the responsibilities and job description for the Reimbursement Specialist position at HBSI?
| Location | US-NJ-Denville | ID | 2024-177298 | Category | Business Professional | Position Type | Full Time | Shift | Days | Job Type | Non-Exempt |
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Under the supervision of the PFS Director, the Reimbursement Specialist position is the lead responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate regulations in order to assure compliance in payment practices.
Education and Work Experience
- Medical and Insurance terminology essential.
- Knowledge of CPT, ICD-9, HCPCS coding structures.
- Experience with payment/EOB review.
- Bachelor's degree preferred
We believe that all persons are entitled to equal employment opportunity and does not discriminate against qualified employees or applicants because of race, color, national origin, ancestry, sex, marital status, child birth or related medical condition or any other protected category as defined by State or Federal Law. We are an equal opportunity employer and do not discriminate against applicants due to veterans status, disability, race, gender or other protected characteristics.
