PeaceHealth Reimbursement Recovery Specialist - Medical Group Non-Government/Commercial Billing in Vancouver, Washington

Req ID: 154874

PeaceHealth is seeking a Reimbursement Recovery Specialist - Medical Group Non-Government/Commercial Billing for a 1.0 full time equivalent Exempt position. This position will be working Day shift with shift durations of 8 Hours.

JOB SUMMARY

Responsible for implementing financial management of complex contract reimbursement terms. Maximizes system reimbursement by ensuring contract compliance. Communicates contract information and audits performance of patient accounts department activities as they relate to contract issues. Provides research and documentation in support of payor audit requests.

ESSENTIAL FUNCTIONS

  1. Analyzes complex contract payment terms for professional and facility-based services.

  2. Reviews claims to identify expected reimbursement for services versus actual reimbursement received. Identifies issues involving pricing of claims issues using established audit model data extract.

  3. Works with payor provider representatives to facilitate resolution or appeal issues of underpayment.

  4. Identifies trends in payment variances from expected. Analyzes and provide summary of financial impact to Payor Contracting leadership.

  5. Documents appeals status and agreements in patient account, electronic medical record (EMR).

  6. Verifies receipt of agreement-related payments and follow-up on receipt of corrective payment issues. Manages relationships with caregivers within Revenue Cycle, acting as resource to identify and resolve payment issues.

  7. Evaluates and make recommendations for single-case reimbursement agreements. Coordinates agreements with Patient Financial Services.

  8. Tracks regulatory agency changes to account reimbursement methods.

  9. Performs other duties as required.

QUALIFICATIONS

EDUCATION:

Associate’s degree in Finance, Accounting, Healthcare Administration, or related discipline; or equivalent combination of education and experience.

EXPERIENCE/TRAINING:

• Minimum three years in claims billing & follow-up, accounting, healthcare accounts receivable, insurance collections or contract administration is required.

• Experience in healthcare insurance contracting is preferred.

• Knowledge of standard health insurer policies, benefit designs and applicable government regulations is required.

• Understanding of insurance coding, claims processing, analysis, and appeals facilitation and processing required.

LICENSE/CERTIFICATION:

• Certification from a recognized accreditation organization in billing preferred.

OTHER SKILLS:

• Able to be self-motivating and work both independently and in conjunction with others.

• Demonstrated diplomacy skills to assertively attend to adversarial situations.

• Demonstrated ability to research issues and reach valid conclusions.

• Demonstrated ability to work on multiple projects simultaneously, meet deadlines as well as recognize and pursue completion of priority assignments.

• Excellent verbal and written communication skills

• Strong organizational and analytical skills

Please apply online to be considered. For full consideration of your skills and abilities, please attach a current resume with your application.

About PeaceHealth

PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 900 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission.

We offer competitive compensation, a robust benefits package at http://www.peacehealth.org/sites/default/files/externalallbenefits_overview.pdf and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver, WA community please visit our homepage: www.peacehealth.org/careers .

Get a feeling for the Spirit of PeaceHealth through this three-minute video , and visit us on Facebook at https://www.facebook.com/PeaceHealthCareers or LinkedIn at http://www.linkedin.com/company/peacehealth !

Questions? Review our Employment FAQ or email Recruitment@peacehealth.org . Please note this email does not accept resumes or applications.

Location: Vancouver, WA, Shared Services Center (802)

Job Category: [[mfield1]]

Shift: Day

Shift Length: 8 Hours

FTE: 1.0

Work Type: Full Time

Hourly compensation starts at: $20.07, more depending on experience

Required Certifications/Licensure:

PeaceHealth is committed to providing equal employment opportunities to all qualified job applicants and employees without regard to the following statuses: protected veteran; qualified individual with a disability; race; ethnicity; religion; gender; pregnancy; gender identity; national origin; age; genetic information; sexual orientation; or any other protected status in accordance with local, state, or federal laws.

The above information is intended to indicate the general nature and level of work performed by this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.

Posting Notes: Vancouver, WA || [[mfield1]] || Full Time || PATIENT ACCOUNTING