Reimbursement Specialist, Day Shift, Patient Financial Services

Overview

Support Center

Adventist Health Care seeks to hire an experienced Reimbursement Specialist for our Patient Financial Services department who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing.

• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of a 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 the 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 indicate 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 it is determined that a denial was inappropriate or additional information is needed for adjudication.
• Routes the denial to the appropriate team after it has been determined that another department should resolve.
• Routes claim to the biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers the unpaid balance to the patient once patient responsibility has been determined.
• Review the Explanation of Benefits for clarity.
• Processes payer changes as needed.

• High School Diploma required, or some college preferred.
• A minimum of 3 years’ experience within a healthcare environment can include an insurance company, a public health setting, or an outsourcing company.
• Frequent pressure due to time constraints
• Frequently works at a PC involving focused concentration.
• Frequent walking, standing, bending, kneeling/crouching, sitting, etc.
• Light physical effort (lifts or carries up to 10lbs)
• Atmosphere and environment associated with an office setting.
• Must maintain a professional appearance and demeanor at all times

Work Schedule: Full-time weekdays

Pay Range: $20.51 - $27.21

Note:

If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.

Under the Fair Labor Standards Act (FLSA), this position is classified as: United States of America (Non-Exempt)

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist Health Care has earned a reputation for high-quality, compassionate care. Adventist Health Care was the first and is the largest healthcare provider in Montgomery County.

Join the Adventist Health Care team today, apply now to be considered!

COVID-19 Vaccination

Adventist Health Care 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. Adventist Health Care will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use. Some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, but marijuana remains illegal under the…