Specialist, Reimbursement

Description

Your experience matters

At Community Medical Centerwe are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and your role youll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our addition to your base compensation this position also offers :

• Health (Medical Dental Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program mental physical and financial wellness assistance
• Tuition Reimbursement / Assistance for qualified applicants
• And much more...

Qualifications & Requirements : High School graduate or equivalent required

Essential Functions : 1. Completes accurate and timely insurance verification.

2. Completes accurate and timely payer authorization requests including ensuring all necessary data elements needed for an authorization (e.g. CPT codes diagnosis codes) are available.

3. Communicates with patients insurers and other appropriate parties pertaining to insurance verification and authorization.

4. Obtain and track insurance authorizations for patient care ensuring timely and accurate processing.

5. Communicate with insurance companies and payers to verify benefits and resolve any authorization issues.

6. Collaborate with clinical and administrative staff to ensure seamless patient scheduling and care coordination.

7. Maintain accurate records of authorization requests approvals and denials.

8. Stay current on payer requirements and authorization processes.

9. Assists with the insurance appeal process and coordination of peer-to-peer.

10. Creates a positive patient experience by being polite compassionate and professional.

11. Maintains productivity and quality performance expectations.

Minimum Education High school diploma

Required Skills :

Requires critical thinking skills decisive judgment and the ability to work with minimal supervision.

Must be able to work in a stressful environment and take appropriate action. Licenses :

Minimum Work Experience 2-5 years in medical billing medical insurance pre-authorization process and / or medical coding. Oncology experience preferred.

Maintains established hospital and departmental policies and procedures objectives performance improvement program safety environment of care management of information and infection control standards.

Demonstrates effective problem-solving an ability to communicate verbally and in writing and a willingness to adapt to changing environment.

Demonstrates professionalism with fellow employees providers and patients in person on the telephone and in writing. Demonstrates by his / her own behavior a strong sense of commitment to patient care. Demonstrates respect for individual dignity and diversity. Coordinates with other departments within the organization in a collaborative environment to ensure appropriate procedures are in compliance with third party payers federal / state law and accrediting / licensing agencies.

Maintains and fosters effective public relations with patients staff partners and the public.

EEOC Statement :

Community Medical Center is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.

Required Experience :

IC

Key Skills

Sales Experience,Crane,Customer Service,Communication skills,Heavy Equipment Operation,Microsoft Word,Case Management,OSHA,Team Management,Catheterization,Microsoft Outlook Calendar,EHS

Employment Type : Part-Time

Experience : years

Vacancy : 1