Reimbursement Specialist - Onsite - Full Time

For over 100 years, West Suburban Medical Center has supported generations of families in the Oak Park and surrounding areas. Our kind, caring hospital staff have a passion to heal and make a difference in our community. We understand that our employees are the heart of our facility. If you are looking for a family atmosphere, a company committed to professional growth and a culture that embraces our five core values of Quality. Innovation. Service. Integrity. Transparency. 

POSITION OVERVIEW

The Reimbursement Specialist is responsible for ensuring accurate reimbursement by reviewing Explanation of Benefits (EOBs), identifying underpayments, and processing contractual adjustments. This role requires diligent follow-up on unpaid claims, maintaining compliance with federal and state billing regulations, and providing insights into denial trends for management reporting. The Reimbursement Specialist will also be tasked with preparing and appealing claim denials to secure proper payment and supporting the insurance authorization and verification process. 

OVERVIEW OF JOB QUALIFICATIONS

• Knowledge of billing regulations, payer reimbursement policies, and medical terminology.
• Strong ability to interpret contract language and EOBs.
• Experience with insurance claims processing, denials management, and appeals preparation.
• Working knowledge of insurance authorization and verification processes.
• Proficiency in using billing and claims software systems for follow-up and adjustment posting.
• Excellent organizational and time management skills.
• Ability to collaborate with team members and escalate issues effectively.

Preferred Qualifications:

• Minimum of 2-3 years of experience in healthcare reimbursement, billing, or claims processing.
• Certified Coder
• Bachelor’s Degree
• Familiarity with major medical insurance plans and their authorization processes.
• Experience in denial management and appeals preparation.
• Knowledge of federal and state healthcare billing regulations.

OVERVIEW JOB DUTIES

• Review EOBs to ensure correct reimbursement and document underpayments.
• Prepare and post contractual adjustments through system input after obtaining necessary approvals.
• Perform timely follow-up on unpaid claims using system worklists, Remittance Advices, EOBs, and other payment documents.
• Process adjustment write-offs, keying and posting via computer input following approval processes as required.
• Ensure timely follow-up of assigned accounts, escalating unresolved issues to Supervisor/Director as necessary.
• Stay up to date with billing rules and regulations to maintain compliance with federal and state laws.
• Track denials and assist in trending and management reporting to improve reimbursement processes.
• Interpret contract language to verify compliance with reimbursement agreements.
• Prepare appeals for claim denials and work towards accurate reimbursement resolution.
• Maintain working knowledge of insurance authorizations and the verification process for major medical insurance plans.
• Serves as a resource for staff and payers seeking to resolve questions and/or concerns related to underpayments and denials.
• Performs special projects as needed and assigned.
• Performs other duties as assigned.

West Suburban Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.