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Rady Children's Hospital San Diego Reimbursement Specialist II in San Diego, California

JOB SUMMARY:

Under the direction of PFS Leadership, the Reimbursement Specialist II is responsible for billing and collections of outstanding account balances for commercial, government, and managed care payors as assigned. The Reimbursement Specialist II is required to identify and report payor issues to their leadership. It is a requirement for the Reimbursement Specialist II to read, interpret and apply complex payor contract language to expected reimbursement calculations and pursue all payments due to the organization. The Reimbursement Specialist II must perform account collection activities utilizing internet resources and professional telephone communication etiquette. The Reimbursement Specialist II is required to compose professional written correspondence with all internal and external entities. This position expects the Reimbursement Specialist II to demonstrate organization and time management skills to manage account collections. The Reimbursement Specialist II identifies payer trends in regards to denials/underpayments and makes appropriate recommendations. Works with payers to resolve denial and underpayment trends. Has a thorough knowledge of the revenue cycle and able to identify process problems impacting AR. Incumbent has a thorough knowledge of industry and payer billing requirements to include claim form requirements and revenue codes. Uses appropriate resources for investigation of denials to include payerguidelines and the UB editor.

MINIMUM REQURIEMENTS:

H.S. Diploma, GED, or Equivalent

Proficient in Microsoft Excel, Word and Outlook programs

Proficient in determining appropriate appeals or adjustments based upon analysis of the denial codes, charges, revenue codes, CPT codes, HCPCS codes, & ICD-9 (10) diagnosis/procedure codes.

3 years of experience or 2 years in a RCHSD Reimbursement Specialist I position exceeding performance expectations with a minimum of a high solid rating.

PREFERRED QUALIFIATIONS:

Associate's Degree

Certification as a HFMA Credentialed Revenue Cycle Representative

EOE including disability/vet

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