Sr. Account Reimbursement Specialist coordinates the billing and followup process between the organization, payers and patients with minimal guidance. Recognizes, researches, reconciles, and reports appropriate corrective action plans on trends related to patient account inquiries and payer denials.
- Processes claims, payments, adjustments, refunds, denials, and unpaid patient and insurance balances.
- Accesses and corrects, if needed, demographic, insurance and financial information.
- Provides accurate account maintenance and documentation.
- Serves as a liaison with insurance companies, third party payors, and administrative personnel.
- Analyzes incoming financial data to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.
- The responsibilities listed are a general overview of the position and additional duties may be assigned.
CODING KNOWLEDGE (NOVICE):- Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS-DRG and APR-DRG prospective payment and severity systems.
DATA ENTRY (INTERMEDIATE):- The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
REVENUE CYCLE (NOVICE):- Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.
- Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance.
- Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.
- Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.
- Team Interaction: Provides informal guidance and support to less experienced team members.
SUPPORTING COLLEAGUES (S3):
- - Develops Self and Others: Continuously improves own skills by identifying development opportunities.
- - Builds and Maintains Relationships : Seeks to understand colleagues' priorities, working styles and develops relationships across areas.
- - Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner.
DELIVERING EXCELLENT SERVICES (S3):
- - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.
- - Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns to supervisors in a timely manner.
- - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support.
ENSURING HIGH QUALITY (S3):
- - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards .
- - Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.
- - Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department.
MANAGING RESOURCES EFFECTIVELY (S3):
- - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service.
- - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources.
- - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error.
FOSTERING INNOVATION (S3):
- - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them.
- - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action.
- - Adapts to Change: Embraces change by keeping an open mind to changing plans and incorporates change instructions into own area of work.