Reimbursement Specialist-full time-days

Employment Type:

Full time

Shift:

Day Shift

Description:

At MercyOne, health care is more than just a doctor’s visit or a place to go when you’re in need of medical attention. Our Mission is based on improving the health of our communities – that means not only when you are sick but keeping you well.

MercyOne Dubuque is the leading hospital in the tri-states, offering the only comprehensive cardiology center and Level II regional neonatal intensive care unit in the area as well as the newly constructed MercyOne Dubuque Cancer Center. Other services include a trauma center, a CARF-accredited inpatient rehabilitation unit, orthopedics, retail pharmacies, palliative care and a wide range of outpatient and community services. MercyOne operates two hospital-based skilled nursing units and a 40-bed nursing home.

In recognition of the strength of its nursing service and the overall quality of patient care, MercyOne Dubuque has been designated a Magnet hospital four consecutive times – the nation’s most prestigious award for nursing excellence.

Join the MercyOne Family! We are looking to hire a Reimbursement Specialist

POSITION PURPOSE:

This position is responsible for all processes relating to the submission and payment of charges for assigned accounts. This includes reviewing and making necessary corrections prior to billing, preparing, and submitting the hardcopy claims generated from Brightree, responding to and resolving all requests for information concerning the receivables, reviewing and addressing partial payments and denials, and reviewing and resolving outstanding receivables not paid in a timely manner. Responds to accounts receivable inquiries/issues and performs assigned tasks and research in a timely, professional manner. Customers include clients, families, third party payers, physicians, referral sources, community, home medical equipment and hospital staff.

General Requirements:

• Performs all related accounts receivable tasks utilizing appropriate policies, guidelines, and standards.

• Ensures compliance with regulatory bodies such as CMS, The Joint Commission, and others.

• Ensures charges are valid and meet the payers’ coverage criteria and documentation requirements prior to generating a claim/invoice.

• Prepares and submits all paper claims in a timely manner.

• Performs follow-up and resolution of all charges rejected at the front-end edits for charges submitted electronically.

• Reviews and resolves all written requests for additional information, all partial payments and all denials that are related to the accounts receivable issues.

What we are looking for:

• High school graduate or equivalent.

• Prefer 1-2 years experience in billing and/or accounts receivable work.

• Prefer background in homecare or other related medical/health field.

• Prefer background/experience in medical equipment receivables including HME reimbursement/coverage and regulatory standards.

• Medical terminology background preferred

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.