Reimbursement Specialist

Job Description

Schedule: Mon-Fri 9am-5pm (2 days remote after training) Salary: $$ / hour The Reimbursement Specialist is charged with coordinating the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. The Reimbursement Specialist is responsible for prioritizing and managing to resolution denied claims with government and third party payers. This includes interpreting payment and denial data down to line item detail, identifying payer and coding trends, risks, and opportunities, to implement operational and/or systematic improvements. Essential to this position are strong quantitative, analytical and organizational skills. Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others. Responsibilities include:

• Research, develop and maintain a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements
• Triage denied claims to identify appropriate action to ensure timely processing and paymen.
• Perform ongoing analysis to determine the root cause of denials and proactively alert management to issues and trends
• Proactively make recommendations for workflow -, operational- and/or systemic changes to reduce denials and speed up collections
• Develop and modify tracking and reporting process for denials, appeals status and appeals results. Ensure that all denials are tracked and the appeals are monitored accordingly.
• Organize, maintain and update the payer database/tracking to house the issues that need to be addressed with third party insurers.
• Maintain expert knowledge of the history of prior disputes and problems to prevent them from recurrence.
• Responsible for creating and submitting timely, comprehensive and compelling appeals to third party payers in order to get denial overturned.
• Responsible for timely follow up on filed appeals via telephone, writing, or the payer website.
• Compile, maintain and distribute reports to management on success of appeals and root cause analysis.
• Serves as department resource related to denials and payer requirements.
• Communicate with internal and external parties (field staff, 3rd party payors, colleagues, others) to assist in education on appropriate submission of claims to avoid repeated denials and rejections.
• Apply findings to internal systems and workflows such as pre-billing edits and system automation.
• Provide information to internal and external auditors as required from time to time.
• Respond to questions related to denials and appeals from internal and external stakeholders.
• Assists with configuration of billing engines.
• Other duties as required.

Why Vinfen?

We are committed to you! We offer great training, great benefits, career growth and job security!

• Medical, Dental and Vision Insurance for employees working 30 hours or more
• 15 days of Vacation, 12 Paid Holidays, 10 Sick Days and 3 Personal Days per year (for employees scheduled for 20 hours or more)
• Education Assistance and Tuition Remission Programs as well as innovative Student Loan Payment Programs. Employment with Vinfen counts toward your Public Student Loan Forgiveness eligibility
• Professional Development programs including year-round online training courses and opportunities to earn CEUs
• Retirement savings programs, including a fully funded, employer sponsored retirement plan and an employee funded 403 (b) plan
• Company paid Life, Accidental Death & Dismemberment and Long-Term Disability Insurance
• Voluntary Term, Whole Life, Accident and Critical Care Insurance
• Flexible Spending Reimbursement Accounts (Health and Dependent care)
• $500 -- $1,000+ Employee Referral Bonuses with no annual cap!
• Other generous benefits including discounted memberships, access to wellness programs and more!

About Us

Founded in 1977, for over 40 years Vinfen has been a leading nonprofit human services organization that "transforms lives" by building the capacity of individuals, families, organizations and communities to learn, thrive and achieve their goals. Vinfen supports thousands of adolescents and adults with psychiatric, developmental and behavioral disabilities at more than 200 sites with over 3,000 employees in eastern Massachusetts and Connecticut.

My Vinfen. My Community. My Job.

Vinfen is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

Requirements

• 2-5 years related work experience, specifically with identifying and resolving healthcare claim denials required.
• High proficiency with Microsoft Excel required, advanced Excelknowledge preferred.
• Proficiency with other Microsoft Office products such as Outlook. Word, PowerPoint and Access
• Prior experience with 3rd party payor claim procedures (websites, systems) required.
• Prior experience with government payors (DMH, DSS) and government claims submission and reporting systems (EIM, MMIS) strongly preferred
• Prior experience with eHana, ARPlus/Hill and Waystar strongly preferred
• Certified Professional Coder (CPC) orCertified Coding Specialist (CCS) preferred.
• Must be able to successfully pass a CORI check, employment verification check, and reference check.

Driving Requirements

No Drivers License check or vehicle required