Reimbursement Specialist

Clerical/Admin Escondido, California

Requisition ID
Patient Financial Services
Escondido, California
Not Applicable
Salary Range
20.21 - 30.36
Job Type
Hours Per Shift
Hours Per Pay Period
Position at Palomar Health

Responsible for the collection of outstanding balances from all Commercial, HMO, PPO and Managed Care payers. Responsible for identifying follow up problems and issues. Check status of claims by telephone, websites and/or other means available. Responsible for providing information and documentation to ensure timely and accurate reimbursement. Manages and assembles all data and documentation required for accurate follow-up of claims to Medicare, Medi-Cal, Commercial, HMO, PPO, Managed Care, Workers� Compensation and other third party payers and guarantors. Collection is performed on all inpatient and outpatient encounters. Must have the ability to perform complex mathematical calculations to adjudicate accounts appropriately. Must have ability to analyze and adjudicate complicated contractual arrangements as determined by contractual agreements entered into by Palomar Health. Reviews remittance codes from EOB�s and RA�s to ensure appropriate payment or to identify denials or non-payment. Once this information is gathered, responsible for follow-up with payer on the routing of claims to the specified department responsible for resolution of the account. Works the current hospital information systems queues/processes set up for their specific assignment/payers as directed by Leadership. Refers all payer issues/problems to Leadership in a timely manner with specific examples. Responsible for complete, accurate, and timely documentation of all follow-up pertaining to the resolution of the account within the current hospital information systems patient financial record. Duties include researching, reviewing and adhering to all federal, state and local regulatory collection guidelines, as well as payor specific billing/collection guidelines. Responsible for directing credit balances/refunds to appropriate department for resolution. Customer service and satisfaction are key standards for all communications. Work will be subject to compliance reviews and productivity standards. Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

Job Requirements

Minimum Education: High School Diploma or combination of education and experience
Preferred Education: Not Applicable
Minimum Experience: 1 year hospital patient accounting experience or Associate's Degree or higher in lieu of experience
Preferred Experience: Not Applicable
Required Certification: Not Applicable
Preferred Certification: Not Applicable
Required License: Not Applicable
Preferred License: Not Applicable

We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.