Reimbursement Specialist Compliance

Job Description

The Reimbursement Specialist is responsible for performing a variety of complex duties, including working insurance claims follow‑up and escalations, interpreting contract language, and tracking trends. This specialist works facility claims ("Hospital billing") and maintains inventory (work queue lists) at acceptable aging levels by prompt review and follow up of claims. Performs all duties in a manner which promotes teamwork and reflects Intermountain mission, vision and values.

• Knowledge in reading explanation of benefits, understanding ANSI codes/denial codes
• Ability to identify trends in underpayments/over payments
• Ability to interpret payer contracts for validation of correct reimbursement on Hospital inpatient/outpatient claims
• Knowledge of all Commercial and Government payers
• Experience in using Excel, creating pivot tables
• Epic training is a plus!

• Responsible for the accurate and timely submission of reconsiderations and disputes.
• Responsible for maintaining work queues at acceptable ageing, by updating accounts and tracking trends.
• Research and resolve a variety of issues relating to payment discrepancies.
• Identify issues and/or trends and communicate findings to management, including payer, system or registration issues.
• Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
• Accurately and thoroughly document findings and actions taken while meeting/exceeding productivity and quality standards
• Participate and attend meetings and training to develop job knowledge and communicate with other caregivers.

• Microsoft Office
• Computer literacy
• HIPAA regulations
• Communication (oral and written)
• Accountability/ability to work independently
• Contract Interpretation
• Customer Service
• Read and interpret EOB’s (Explanation of Benefits).
• Knowledge of medical billing and collections
• Medical terminology
• Participate and lead special projects, as assigned. Oversee work flow implementation with internal and external partners. Compile and coordinate materials and feedback on special projects. Trains and mentors new associates to the department. Serves as a subject matter expert and resource to answer questions within the department.

• High School Diploma or equivalent, required
• Must obtain CSPR or CRCR credentials with 1 yr of hire date (provided through employer)
• Minimum of three (3) years of experience in revenue cycle insurance follow up or denial management, required
• Extensive knowledge of managed care contract interpretation, required
• Associate's Degree, preferred
• At least three (3) years of work experience in a complex invoice/billing/reconciliation environment, preferred

Knowledge of revenue and ICD 10 coding practices

"Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings."

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states:
California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington.

• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set‑up and use.
• Expected to lift and utilize full range of movement to transport, pull, and push equipment. Will also work on hands and knees and bend to set‑up, troubleshoot, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.

For roles requiring driving:
Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Peaks Regional Office

Broomfield

Colorado

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$24.00 - $36.54

We care about your well‑being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a…