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Reimbursement Specialist, Day Shift (Hybrid), Patient Financial Services
Adventist HealthCareGaithersburg, United Statesfull_timeVerifiedPosted 19 Jun 2024
About the role
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If you are a current Adventist HealthCare employee, please click this link to apply through your Workday account.
Adventist HealthCare seeks to hire an experienced Reimbursement Specialist for the Patient Financial Services Department who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing.
As a Reimbursement Specialist, you will,
•Establishes the payment status of billed or partially paid claims.
•Determines the root cause of denial or partially paid claim.
•Contact the payer either by phone call or online payer portal to determine if the payer is requesting additional information to adjudicate the claim.
•Obtain payment or commitment from payer to pay.
•Obtains status on billed, resubmitted, appealed, and reconsideration claims.
•Determines if the claim is on file.
•Files appeal after review of a denial indicates an appeal is needed or the payer agrees to reprocess the claim.
•Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contact the payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
•Routes denial to the appropriate team after a denial has been determined that another department should resolve.
•Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
•Transfers unpaid balance to the patient once patient responsibility has been determined.
• Review the Explanation of Benefits for clarity.
•Processes payer changes as needed.
Qualifications include:
•High School Diploma required, or some college preferred.
•A minimum of 3 years' experience within a healthcare environment can include an insurance company, public health setting, or an outsourcing company.
Work Schedule:
Day Shift (Hybrid) Monday - Friday, 8:30 am - 5:00 pm.
#GR8 Accounting & Finance
At Adventist HealthCare our job is to care for you.
We do this by offering:
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today, apply now to be considered!
COVID-19 Vaccination
Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, et
If you are a current Adventist HealthCare employee, please click this link to apply through your Workday account.
Adventist HealthCare seeks to hire an experienced Reimbursement Specialist for the Patient Financial Services Department who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing.
As a Reimbursement Specialist, you will,
•Establishes the payment status of billed or partially paid claims.
•Determines the root cause of denial or partially paid claim.
•Contact the payer either by phone call or online payer portal to determine if the payer is requesting additional information to adjudicate the claim.
•Obtain payment or commitment from payer to pay.
•Obtains status on billed, resubmitted, appealed, and reconsideration claims.
•Determines if the claim is on file.
•Files appeal after review of a denial indicates an appeal is needed or the payer agrees to reprocess the claim.
•Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contact the payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
•Routes denial to the appropriate team after a denial has been determined that another department should resolve.
•Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
•Transfers unpaid balance to the patient once patient responsibility has been determined.
• Review the Explanation of Benefits for clarity.
•Processes payer changes as needed.
Qualifications include:
•High School Diploma required, or some college preferred.
•A minimum of 3 years' experience within a healthcare environment can include an insurance company, public health setting, or an outsourcing company.
Work Schedule:
Day Shift (Hybrid) Monday - Friday, 8:30 am - 5:00 pm.
#GR8 Accounting & Finance
At Adventist HealthCare our job is to care for you.
We do this by offering:
- Work life balance through nonrotating shifts
- Recognition and rewards for professional expertise
- 403(b) retirement plan
- Free Employee parking
- Benefits Eligible Positions:
- Competitive, comprehensive benefit plans [including health, employer-paid disability and life insurance, PTO]
- Employer retirement contribution and match after 1-year of eligible employment with 3 year vesting
- Ancillary benefits such as flexible spending, legal and pet insurance to meet the needs of employees and their eligible family members
- Subsidized childcare at participating childcare centers
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today, apply now to be considered!
COVID-19 Vaccination
Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, et
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