Reimbursement Specialist (Full Time) Position Available In Calcasieu, Louisiana

Reimbursement Specialist (Full Time)

Department:

Business Office

Location:

Lake Charles, LA
DESCRIPTION

OF POSITION

Reimbursement specialists are responsible for evaluating and overturning denials to provide denial trend information to leadership. As an integral role of the Claims Escalation Team, the Reimbursement Specialist monitors outstanding payer issues and provides intensive follow up to ensure billing, coding, and collection process are followed to maximize reimbursement.

SUPERVISION

Reports directly to the Collection Supervisor

RESPONSIBILITIES AND DUTIES

Accurately identifies and evaluates denials and underpayments in order to determine reason and investigates the issue to determine the best course of action to have payer pay at the maximum reimbursement allowed per our contract.
Understands payer contracts and how to analyze them in order to preview an account to determine if properly paid and identify when errors are made in payments.
Utilizes system resources in order to compile reports and provide accurate feedback regarding Denials and Underpayments to Leadership.
Communicates effectively with assigned payer, other departments and leadership to identify trends, help find solutions and implement changes that will positively affect reimbursement.
Accurately evaluates each account in order to determine what is needed, what is left outstanding, and what steps are necessary to resolve the account quickly.
Properly utilizes productivity tracking mechanisms.
Works at or above the weekly set productivity standard and completes tasks in a timely manner.
Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
Documents all information in the System following the Clear Concise Consistent method.
Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
Writes clearly and informatively.
Edits work for spelling and grammar.
Varies writing style to meet needs.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

High school graduate or GED certificate, required.
Minimum of 2-year experience in Healthcare, preferably in the insurance industry
Proficient in Microsoft Office suite
Analytical and problem-solving skills
Excellent communication and interpersonal skills
Ability to work well in a team environment
Adequate keyboarding skills (40 words per minute typing rate)
Strong organizational and communication skills, including ability to discuss medical issues.
Negotiation skills including assertiveness and being proactive.
Physical Demands/Work Environment
Work requires light duty lifting.
Must be able to remain in a stationary position 50% of the time.
Constantly operates a computer and other office machinery such as calculator, copy machine, and computer printer.
Must be able to exchange accurate information with patient, family, peers and medical personnel.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.
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