HIM Certified Payment & Reimbursement Specialist

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process.

Department: Health Information Management
Shift/schedule: Full Time (40 hrs/wk)

GENERAL SUMMARY

The Certified Payment & Reimbursement Specialist works under the supervision of the Administrative Director of Health Information Management. The Primary job duties include completing, tracking and reporting denials. Developing innovative reporting, trend analysis and performance metrics. Works RCW denial reports and redistributes work based on policy. Monitors and compares denial reports to RCW trackers.  Work box reports to determine the need for appeal along with other relevant denial related reports.  Disperses paper mail to the appropriate location, monitors portals for electronic denial letters and works closely with UR Case Management team and the Denial Prevention Appeals Coordinator.  Performs other duties as assigned.

QUALIFICATIONS

Education:

• High School Diploma or successful completion of an equivalent High School Exam Required
• Hospital reimbursement knowledge preferred
• Excel courses preferred

Licensure:

• CSPR within one year of hire required

Experience:

• Two years of mid-revenue cycle experience preferred

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS

The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 

1. Complies with all policies and procedures.

2. Tracks and trends denials using excel spreadsheets and RCW software.

3. Reviews denial tracking reports to determine what accounts need appealed or rebilled based on specific criteria.

4. Monitors peer-to-peer loss report to ensure timely filing limits are not surpassed.

5. Reviews reports to verify exceptions.

6. Works case manager pending reports to ensure holds are accurate.

7. Coordinates denial related mail and distributes according to policy.

8. Monitors insurance portals for electronic denials.

9. Reviews denials from claims and makes corrections according to policy.

10. Performs other duties as assigned.

Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status

Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.