This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2235430

The Reimbursement Specialist I is responsible for the timely and compliant submission of technical (hospital) and professional claims (HB and PB) to insurance companies, government agencies and patients.This individual identifies and analyzes denials and payment variances. They will enact the appropriate corrective measure as needed to effectively communicate and resolve payer errors.

Essential Job Functions:

• Examines denied and underpaid claims to determine reasons for discrepanciesCommunicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement. Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R.
• Perform duties in compliance with state and federal regulatory requirements, and Clearwater Valley Health and St. Marys Health policies and procedures governing Revenue Cycle compliant processes.
• Work reports as directed by manager.
• Attends meetings and huddles on a daily, weekly or monthly basis organized by manager.
• Help identify issues to help create solutions with the guidance of your team members and manager.
• Ability to effectively work as a team with good communication skills. (verbally and written)
• Provide excellent customer service with patients and team members. (internal and external)
• Any other duties assigned by the manager.
• Maintains confidentiality of all hospital and patient information at all times.
• Follows HIPAA regulations and policies.
• Regular and predictable attendance is an essential job function.

Minimum Qualifications:

• High school diploma or equivalent required.
• 1 - 3years experience in related service preferred.
• Medical terminology familiarity preferred.
• Demonstrated competence working in Microsoft Office applications, including Excel and Word.
• Excellent communication and organizational skills required.

Work Environment:

• This is a remote eligible position.
• Marys and Clearwater Valley Health operates 24 hours per day each day of the year; operational needs of departments may require that you be available to work all shifts, weekends and holidays to meet the needs of the patients.
• Marys and Clearwater Valley Health Clinic locations have operation hours based on locations and patient needs therefore availability to work all clinic shifts, weekends and holidays as appropriate for location will be expected and required.
• Work is normally performed in a typical interior work environment.

Joint position, Full time

CVH is EOE