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 sophisticated payor contract language to expected reimbursement calculations and pursue all payments due to the organization. The Reimbursement Specialist II must perform account collection activities using 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 leadership 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 detailed knowledge of the revenue cycle and able to identify process problems impacting Accounts Receivable.

REQUIRED SKILLS:

- Strong analytical skills

- Expert communicator

- Creative problem-solver

- Exceptional time-management skills

MINIMUM REQURIEMENTS:

- High School Diploma, G.E.D. or equivalent

- Proficient in Microsoft Excel, Word and Outlook programs

- Proficient in resolving appropriate appeals or adjustments based upon analysis of the denial codes, charges, CPT and ICD-10 codes

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

PREFERRED QUALIFIATIONS:

- Associate Degree

- Certification as a HFMA Credentialed Revenue Cycle Representative

The current salary range for this position is $23.10 to $31.77

Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.