Reimbursement Specialist - Healthcare jobs in South Carolina

REVENUE RECOVERY SPECIALIST : REIMBURSEMENT TEAM, DAYS (M-F)-24001588

Administrative / Clerical / Professional

Primary Location

Columbia

Schedule

Full-time

Shift

Day Job

Unposting Date

Ongoing

Description

HOURS : Monday through Friday 8 : 00 AM to 4 : 00 PM

DEPARTMENT : Patient Financial Services

WORK LOCATION : Onsite or Remote work available. Opportunity to work remote - Remote staff are required to come on site once approximately every 5 weeks.

SALARY : $22.00 - $34.74 / HR

ABOUT MU HEALTH CARE

MU Health Care is a growing academic health system in mid-Missouri comprised of multiple hospitals including the region’s only Level 1 Trauma Center and region’s only Children’s Hospital and over 50 specialty clinics located throughout the region.

As an MU Health Care employee, you’ll be part of an exceptional team committed to our mission of saving and improving lives.

Our core values of inclusion, respect, service, discovery, responsibility and excellence foster a collaborative work environment where you can grow your career.

BASIC FUNCTION AND RESPONSIBILITY

To monitor, analyze, and appeal government, managed care and commercial payer hospital and outpatient hospital-based patient claim payment variances in order to optimize revenue recovery, assess contract compliance, and communicate contract and reimbursement issues to management.

CHARACTERISTIC DUTIES

Perform a variety of tasks related to developing a knowledge-base and understanding of government payer regulations, terms of third party payer regulations and contracts, coverage and benefit plans, coordination of benefits, payment terms and all other conditions affecting payment, appeal of payment variances and correct payment calculation.

Perform a variety of tasks related to use of internal data and systems to identify, document, track and summarize payment variances to determine appropriate actions to be taken so as to initiate appeals and to address inaccurate reimbursement in a timely manner.

Perform a variety of tasks to analyze internal processes, technical system issues and payer processing / system issues and to determine / communicate corrective actions in order to resolve payment variances.

Perform a variety of tasks, in conjunction with Managed Care Contracting and Government Payers Department staff, to achieve most accurate payer and contract modeling in the decision support system.

Perform a variety of tasks to document appeals of payment variances and reimbursement amounts recovered thru the various appeals processes.

Perform special projects, as assigned, in order to resolve recovery issues, settlements with payers and optimize revenue recovery.

SUPERVISION RECEIVED

Administrative supervision is received from the Supervisor, Revenue Management.

SUPERVISION EXERCISED

None

EMPLOYEE BENEFITS

• Health, vision and dental insurance coverage starting day one
• Generous paid leave and paid time off, including nine holidays
• Multiple retirement options, including 100% matching up to 8% and full vesting in three years
• Tuition assistance for employees (75%) and immediate family members (50%)
• Discounts on cell phone plans, rental cars, gyms, hotels and more

See a comprehensive list of benefits .

Qualifications

QUALIFICATIONS

A bachelor’s degree in Accounting, Business Administration, Finance, Health Related Professions, Nursing or an equivalent combination of education and experience from which comparable knowledge and abilities can be obtained is required.

Minimum of three years experience in business acumen, insurance or managed care industry, hospital patient accounts or a related health-care area such as utilization management, case management or hospital audit and reimbursement is required.

Experience in health related contractual analysis involving rate and language analysis, audit and reimbursement, claims denial and appeals experience is preferred.

Knowledge of or willingness to learn fundamentals of coding CPT / HCPCS, ICD-9 and / or ICD-10, DRG’s and APC’s is perferred.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation.

The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and / or move objects above the shoulders and below the knees.

The employee may be required to move objects up to 10 lbs.

PERFORMANCE EXPECTATIONS

This job description is not designed to cover or contain a comprehensive listing of activates, duties or responsibilities that are required of the employee for this job;

however, completion of these duties is a measure of successful performance. Employees of this job classification are subject to quarterly performance reviews.

Basic function, responsibilities and characteristics duties may change at any time with or without notice.

The University of Missouri System is an Equal Opportunity Employer. Equal Opportunity is and shall be provided for all employees and applicants for employment on the basis of their demonstrated ability and competence without unlawful discrimination on the basis of their race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law.

This policy applies to all employment decisions including, but not limited to, recruiting, hiring, training, promotions, pay practices, benefits, disciplinary actions and terminations. For more information, visit

All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity, gender expression, age, disability, or protected veteran status, or any other status protected by applicable state or federal law.

Last updated : 2024-05-20