Medical Reimbursement Specialist

Description

Job Summary:

The Medical Reimbursement Specialist will report to the Director of Payer Services. They will complete daily reimbursement processes, research claims and billing issues, and monitor compliance with payer agreements. This role involves tracking denials and adjustments, researching reimbursement concerns, and working closely with payers to resolve claims and portal issues. The specialist will also verify claim processing for new providers and maintain updated payer rosters. Regular communication with payers, attending quarterly and monthly meetings, and staying informed on industry updates are key aspects of the role.

Essential Functions & Responsibilities:

• Execute daily reimbursement operations and report operational issues.
• Assist with claims resolution and research reimbursement concerns.
• Submit requests for new CPT codes and ensure accurate reimbursement.
• Track and address denials, adjustments, and billing issues.
• Manage payer communications and attend quarterly and monthly meetings
• Maintain and update payer rosters, including attestations and cancer registry submissions.
• Complete single case agreements with non-contracting providers
• Report relevant payer updates to Director of Payer Contracts and assist with process changes.
• Practice and adhere to the Code of Conduct philosophy and Mission and Value Statements and policies of the Hutchinson Clinic.

Additional Responsibilities:

• Perform other duties that may be assigned from time to time.

Qualifications

Experience:

• Experience in healthcare reimbursement or insurance operations.
• Proficient in healthcare billing systems and payer portals.
• Familiarity with CPT codes, payer contracts, and reimbursement policies.
• Proficient with Excel and formulas
• Strong problem-solving and communication skills.
• Preferred experience with Crystal reports, SQL, or other basic computer programing language
• Two years of business office or related experience in a healthcare organization.

Education:

• High School Education or equivalent required.
• Associate degree in business or related field required.
• Bachelor’s degree in business administration or equivalent experience preferred.

Physical Requirements:

• Requires sitting for extended periods of time; also stooping, bending, and stretching for files and supplies.
• Requires manual dexterity sufficient to operate a computer keyboard.
• Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts.

Other Skills:

• Organization - proactively prioritizes organizational needs and effectively manages resources.
• Computer Skills - demonstrates intermediate proficiency in Microsoft Office applications.
• Ability to motivate or influence others.
• Policies and Procedures- articulates knowledge and understanding of organizational policies, procedures and systems.
• Must possess excellent verbal and written communication as well as excellent interpersonal skills with, staff, health care professionals and outside contacts.

This job description may not be inclusive of all assigned duties, responsibilities, or aspects of the job described, and may be amended at any time at the sole discretion of Hutchinson Clinic.