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Medical Reimbursement Specialist - Home Health

Medical Reimbursement Specialist - Home Health

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Job Snapshot

Employment Type Full-Time
Job Type Admin - Clerical, Health Care, Other
Education Not Specified
Experience Not Specified
Manages Others No
Industry Healthcare - Health Services, Managed Care, Other Great Industries
Required Travel Not Specified

Job Description

Reimbursement Specialist

SUMMARY

The Reimbursement Specialist will collect and process claims and payments for all branches. The Reimbursement Specialist checks eligibility and authorization of Medicare and Medicare PPS payors. Functions of this role performed timely and accurately, affect patient satisfaction, and quality outcomes. The Reimbursement Specialist complies with all legal, Medicare & private insurance and company rules and regulations.

As an organization, we strive to succeed in the three critical success factors listed below. Every team member contributes to the overall goals as shown in the performance outcomes.

 CRITICAL SUCCESS FACTORS:

  • Patient/Customer Satisfaction – to exceed the national average in publically reported patient satisfaction

  • Quality Outcomes -  dedication to process excellence and best in class in readmission rate

  • Financial and System Growth – to operate in a fiscally responsible manner and continue to grow the business.

PERFORMANCE OUTCOMES

Outcome 1: Patients/Customers are confident with our payment services

Critical Success Factors: Patient/Customer Satisfaction, Financial and System Growth

Responsibilities to Achieve Outcome 1:

  • Process co-pay and deductible patient letters

  • Post payments (electronic payments and live checks)

  • Process files for electronic and paper claims submitted for all branches

  • Assists clients, their families and co-workers in understanding records and reimbursement procedures

     

Outcome 2: Patients receive seamless post-acute services with no delay or interruption of services.

Critical Success Factors: Patient/Customer Satisfaction, Quality Outcomes/ Financial and System Growth.

Responsibilities to Achieve Outcome 2:

  • Checks eligibility for Medicare and other Medicare PPS Insurance payors

  • Add new payors into HCHB

  • Proactively addresses Insurance challenges

Outcome 3: Compliance with all federal, state, and agency rules and regulations

Critical Success Factors:  Quality Outcomes, Financial and System Growth

Responsibilities to Achieve Outcome 3:

  • Understands and practices  agency policies and procedures

  • Continually improves practices

  • Follows all legal rules and regulations

  • Attends in-services, educational programs and meetings as necessary

Job Requirements

QUALIFICATIONS:

Education/Experience: High school diploma or equivalent.  Knowledge of medical terminology and clerical experience is preferred.

Interpersonal Skills: Excellent oral and written communication skills.

Technical Skills: Proficiency in Microsoft Excel, Word, and Outlook. Experience working with computers is required.

Miscellaneous Skills: Detail oriented and ability to prioritize responsibilities.

Health Requirements: Employee must be free of physical/medical conditions that would limit or restrict their ability to perform the job functions listed below.  Bloodborne Exposure risk is none.

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Medical Reimbursement Specialist - Home Health


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