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The health and safety of our patients and employees is our highest priority. We have mobilized a swift, efficient, and comprehensive response to the current situation related to COVID-19 so that our staff can stay on the front lines, giving care safely. We welcome your application and will connect with you as soon as we can, possibly virtually. Please note that many positions will not be progressing as fast as they normally would, as we prioritize our current needs. Although some positions will be on hold while we focus on providing support for our staff, trust that your application will be reviewed and considered for future openings.

Reimbursement Specialist II

San Diego, California
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Job ID 4219 Date posted 09/15/2020 Schedule Full-Time Shift Day Department Reimbursement Service

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

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  • Reimbursement Service, San Diego, California, United StatesRemove