Reimbursement Specialist

The Reimbursement Specialist works as part of the reimbursement department to facilitate efficient operation of the agency’s billing system. This position assists the reimbursement department for data entry of services, client demographic information and special projects and deadlines. The Reimbursement Specialist assists in preparing data to submit claim files for payment. This position answers to the Reimbursement Manager.

ESSENTIAL DUTIES and RESPONSIBILITIES include but may not be limited to the following:

Reports to work on time, as scheduled and at the location assigned.

• Works cooperatively as a team member.
• Participates in department meetings.
• Participates in developing problem-solving strategies related to department support duties and needs.
• Responsible for electronically submitting client data to all payors including our Network data for reimbursement after verifying eligibility through the edit process.
• Accurately enters client demographic information and insurance information into the agency information and billing system.
• Log on to MHWIN for verification of client status (Medicaid or non-insured) within the DWIHN system, if assigned.
• Responsible for all insurance billing on a regular schedule, problem solving any rejections and posting any payments or credits including 835 files.
• Responsible for electronically submitting client data to all payors including our Network data for reimbursement after verifying eligibility through the edit process.
• Communicates pleasantly, effectively and professionally, by telephone, and in person with co-workers and clients.
• Answers questions about the organization and provides callers with address, directions and other general information.
• Able to withstand pressure and remain poised during stress related situations.
• Travels to and works at all sites as necessary.
• Completes other assigned responsibilities and special projects in a reasonable established timeframe, with quality expectations.

COMPETENCIES

Communication- Uses effective oral & written communication with internal staff, vendors and community representatives; demonstrating empathy & listening. Collaborates with staff and management to accomplish departmental & agency goals by applying the following approaches:

• Communication approach
• Inquiry and listening
• Collaboration

The reimbursement specialist demonstrates excellence in communication skills and collaborates with colleagues and external entities utilizing clear and concise communication and professionalism.

Ownership and Quality of Work- Effectively manages own work, and work of teams when relevant, ensuring delivery of high-quality work:

• Taking ownership
• Quality of work product

The reimbursement specialist efficiently gathers, prepares and submits billing data and claims and consistently meets required timeframes and ensures the highest quality of service delivery.

Cultural Humility-Demonstrates the value of diversity and inclusion; fosters an inclusive environment that facilitates a diverse team thriving within the organization:

• Awareness
• Advancing diversity and inclusion

The reimbursement specialist values diversity and inclusion in the workplace; is respectful of the opinions of others and has awareness of the value of a multiple lens cultural perspective; contributing to the advancement of diversity and inclusion leading to a strengthened workforce and quality services.

QUALIFICATIONS - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE – High school diploma. Experience in working with people. Experience in Microsoft office applications. Billing experience preferred.

LANGUAGE SKILLS - Must have excellent communication skills, both written and verbal. Ability to work cohesively as a team member and interact with staff and vendors appropriately.

PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.