Reimbursement Specialist

Reimbursement Specialist
In San Diego, California 92123

Job Description

Workway is a professional staffing firm, working with organizations across the country to place exceptional candidates. Work with the largest children's hospital in California providing the largest source of comprenhesive pediatric medical Services in San Diego, Riverside and Imperial counties. Working within this not-for-profit organization, you'll contribute to ensuring the lives of hundreds of sick or injured children receive the best possible medical care.

Job Description

We are looking for a Reimbursement Specialist responsible for billing & collections of outstanding account balances for commercial, government, & managed care payors as assigned in accordance with federal, state, industry regulations & standards. Your specific job duties:

  • Resolve all claim edits, stop bills, & account edits including late charges, charge errors, consecutive accounts, duplicate accounts, & claim errors in order to submit timely & accurate claims to government agencies, commercial payers, & other payers as assigned. 
  • Apply complex contractual arrangements to identify expected reimbursement to include fee schedules, per diems, high dollar stop loss, DRGs, APCs, & carve outs. 
  • Review all denials/underpayments & take corrective action based upon national denial reason codes, remark codes & payer specific codes. 
  • Processes overpayments within the guidelines of federal & state regulations, payer requirements, & hospital standard procedures. 
  • Receives & processes requests from patient families, insurance carriers, government entities, & other sources. Must provide appropriate requested information to ensure quality customer service & appropriate adjudication of claims.

Specific qualifications for the position include

  • High School Diploma or equivalent required.
  • 2+ years of billing and collections experience in a hospital setting with commercial insurance carriers required.

Let one of our recruiters assist you in finding and preparing for interviews with our clients. Whether you are interested in a direct hire, temp-to-hire, or temporary position, Workway can help you to put your best foot forward. Contact us today! 

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Abhijeet Pathak