Reimbursement Specialist

HOMELINK, a business unit within VGM Group’s family of businesses, is an innovative national provider of integrated specialty services for the healthcare and workers’ compensation industries. HOMELINK provides a comprehensive offering of ancillary care products and services, including advanced clinical programs, and partners with both payers and providers. As a privately held, employee-owned company, HOMELINK team members are committed to delivering high quality service from referral to resolution. To learn more about VGM HOMELINK, visit our website at www.vgmhomelink.com.  

Position Summary 

The Reimbursement Specialist is a subject matter expert for workers’ compensation and CMS Medicare fee schedules and bill review. The Reimbursement Specialist is responsible for determining appropriateness of charges, enforcing bill review edits, and maintaining up-to-date knowledge of federal and state fee schedules, rules, and regulations.  

All HOMELINK team members will be expected to follow strict confidentiality and HIPAA privacy and security guidelines. 

What’s more? At VGM Group, we are 100% employee owned. Click to view more about VGM!   

Reporting to: TBD  

Working Location: On-site in Waterloo, IA, hybrid, or remote opportunities available.Employees whose primary residence is around a 30-mile radius of VGM Main Campus are expected to work onsite at least four days per week. Specifics will be under the leader's discretion and subject to manager approval and business needs.  

Work Hours Classification: Full-time, Monday-Friday  

Key Responsibilities

Duties Include:

• Analyze, interpret, and maintain relevant knowledge of federal, state, workers' compensation, commercial, and third-party pricing
• Research all required sources of documentation for federal and state fee schedules, including current data and fee schedule information
• Educate operations and technical teams and update documentation pertaining to regulatory changes
• Educate leadership, sales, and account management teams about major pricing changes to Medicare and workers' compensation fee schedules.
• Ensure that billing practices adhere to payer regulations and industry standards
• Provide expertise on which bills to formally dispute with bill review companies.
• Assist with audit readiness and payer audits.
• Use CPT, HCPCS and ICD-10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rationale
• Represent HOMELINK on external client-facing calls as a subject matter expert in the above areas
• Other duties as assigned

Key Qualifications

Education and experience:

• Minimum 5 years workers’ compensation and/or group health bill review experience
• Revenue Cycle Management Specialist and/or Certified Professional Coder certifications preferred
• Must comply with continuing education per Company, regulatory, contractual, and accreditation requirements.

Skills and competencies:

• Knowledge of healthcare industry billing and/or coding terminologies such as ICD-10, HCPCS, CPT, and modifiers.
• Exemplary relationship management skills to communicate effectively with employees, management, and insurance companies
• Ability to routinely adapt to change while working in a fast paced, complex environment
• Team player with excellent communication skills
• Strong time management and organization skills
• Strong analytical and problem-solving skills

Physical requirements: 

• Operation of office equipment and using technology efficiently such as computers, phones, misc. office equipment       
• Visual abilities to include reading, distance vision and peripheral vision 
• Moving throughout the VGM facilities when needed.

Learn more about VGM Group, Inc.:  

Headquartered in Waterloo, Iowa, VGM is a 100% employee-owned company providing business and professional services to thousands of business customers across North America. Services include group purchasing, commercial insurance, management of healthcare services and networks in post-acute cases, healthcare distribution direct to patient homes, specialty consulting, online education, digital, print, and traditional marketing and more. VGM employs approximately 1,700 people across 40 states and Canada, with more than 1,100 working in Iowa. VGM has been named the Top Workplace in Iowa on multiple occasions and is proud of its role in the communities in which it serves. For more information visit www.vgmgroup.com.  

Compensation Overview:  

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.  

This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Reasonably related additional duties may be assigned to the individual Associate.

VGM Group, Inc. 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.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.