What are the responsibilities and job description for the Reimbursement Representative position at Swedish American?
Pay Range : $19.04 - $25.71 / hour
Additional components of compensation may include :
Evening & night shift differential
- Overtime
- On-call pay
Benefits information : https : / / careers.uwhealth.org / benefits /
At UW Health in northern Illinois, you will have :
POSITION SUMMARY :
The Reimbursement Representative is responsible for a portfolio of accounts receivable and is engaged in pro-active collection of outstanding balances, including accurate and timely processing of appeals, with government or third-party payors.
Prompt resolution of outstanding balances involves working with UW Health internal and external customers (e.g., third party payers, patients and their guarantors, estate representatives, attorneys, clinicians, employers, and UW Health employees). Additionally, this position requires a thorough understanding of often complex contracts, third party payer requirements, government regulations, and in-house computer applications for billing and account receivables.
EDUCATION / TRAINING :
Minimum :
High School Diploma or equivalent
Preferred :
Associate's Degree in Business, Finance, Health Information Management, or related field
LICENSURE / CERTIFICATION :
Minimum :
N / A
Preferred :
N / A
EXPERIENCE : Minimum :
1 year of experience in an insurance, finance, medical, hospital, or customer service-related field.
Preferred :
REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES :
Ability to make good judgments in demanding situations
Ability to react to frequent changes in duties and volume of work
Effective communication skills
Ability to listen empathetically
Ability to logically and accurately organize details
Ability to manage multiple tasks with ease and efficiency
Self-starter with a willingness to try new ideas
Ability to work independently and be result oriented
Positive, can-do attitude coupled with a sense of urgency
Effective interpersonal skills, including the ability to promote teamwork
Strong problem solving skills
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders
Ability to use various computer applications including EPIC
Excellent PC operating skills (keyboard, mouse) and use of MS Office
Broad knowledge of health care business office practices and principles
Basic math skills and knowledge of general accounting principles
Maintain confidentiality of sensitive information
Knowledge of Business Office policies and procedures
Knowledge of local, state and federal healthcare regulations
MAJOR RESPONSIBILITIES :
Core Responsibilities :
Follow up with third party payers and patients on outstanding account balances (including credit balances) to facilitate prompt resolution of outstanding account balances. This includes :
o Analyze and reconcile denied payment transactions.
o Compile and file all information needed to appeal denials
o Following federal and state regulations to ensure compliance standards are met
o Monitor timely filing requirements on claims and appeals
o Follow-up with contracted payers to secure payments on outstanding balances
o Evaluate third party payments to ensure accuracy relative to contract language (underpayment / overpayment)
Verify patient coverage information and update registration as required
Accurately document all actions taken to reconcile outstanding balances
Communicate with Revenue Cycle teams, payers and others to resolve account problems
Evaluate the payment status of outstanding third party claims and resolve any impediments to payment by providing information such as appropriate medical records, detailed itemization of charges, information regarding other insurance benefits, and explanation of charges.
Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement and coverage, contracts, services provided.
Review charges to ensure we are filling to correct guarantor (e.g. work comp vs. personal / family)
Complete work on special projects, queries and reports as assigned
Customer Service Standards :
Support co-workers and engage in positive interactions.
Communicate professionally and timely with internal and external customers
Demonstrate friendliness by smiling and making eye contact when greeting all customers.
Provide helpful assistance in anticipating and responding to the needs of our customers.
Collaborate with customers in planning and decision making to result in optimal solutions.
Ability to stay calm under pressure and deal effectively with difficult people
Our Commitment to Diversity, Equity, and Inclusion
UW Health is committed to being a diverse, inclusive and anti-racist workplace and is an Equal Employment Opportunity, Affirmative Action employer. Our integrity shines through in patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. Applications from Black, Indigenous and People of Color (BIPOC) individuals, LGBTQ and non-binary identities, women, persons with disabilities, military service members and veterans are strongly encouraged. EOE, including disability / veterans.
PI259805663
Salary : $19 - $26
