at NorthShore University Health System in Skokie, Illinois, United States
Job Description
Position Highlights:
*Position: Reimbursement Specialist
*Location: [Skokie, IL; possibility of Arlington Heights]
*Full Time/Part Time: [Full Time]
*Hours: Monday-Friday, [8am to 430pm with some flexibility and possible compressed work week]
*Required Travel: No
What you will need:
Education: High School Graduate or Equivalent
Certification: N/A
Experience: Two to five years billing and insurance follow-up experience preferred.
Skills:
Communication:
Effective communication as demonstrated through professional written and verbal skills.
Ability to build positive relationships with all internal or External customers.
The ability to read and interpret insurance contracts.
Computer:
Keyboarding and 10-key proficiency.
Mouse proficiency.
PC applications in a Windows environment, minimum, with MS Word and Excel, preferred.
Light typing of 25-30 wpm.
Organizational:
Able to prioritize workload.
Able to handle expected volume of work.
Ability to retain composure in a stressful environment.
Adapts well to change.
Able to quickly problem solve and escalate appropriate problems to supervisor.
*Physical Demands/Environmental Conditions:Employee sits 85% of the day. Fine manipulation with one hand is required for use of pens, calculator, computer keyboard. Visual acuity requires extensive reading on the computer, typed or handwritten pages and use of peripheral vision. Employee occasionally is attentive to or distinguishes between tones (i.e. computer signals, timers, alarms) and continually uses the telephone.
Duties and Responsibilities:
Manages Payor Relationships
*Maintains relationships with plan's Provider Representative.
*Facilitates operational meetings with plan's Provider Representative, as needed.
*Follows up with Provider Representative as needed to ensure closure on issues.
Identify Discrepancies
*Responsible for understanding the Epic program/system and helping with its development; in order to more efficiently capture underpayments by identifying necessary system changes either in the pricing of claims or system modifications that will enhance NorthShore productivity.
*Reviews accounts referred by Revenue Cycle to determine payment errors based on contract and/or and trended issues.
*Notifies analyst of contract load discrepancy if claims issues are system related.
*Requests and determines report criteria to be run, as necessary.
*If errors are determined to be a trended issue; contacts insurance company to appeal and seek resolution.
*Reports trends by insurance to supervisor.
*Manages payer log spreadsheets to be submitted to the health plans.
*Notate account of findings, as necessary.
*Reports dollars recovered to supervisor and revenue cycle stakeholders.
Contract Resource Book and EPIC
*Responsible for updating and/or creating new CRB (contract resource book) sheets for all managed care payors and distribution to various internal departments.
*Validate Epic if is pricing correctly once loaded and bring pricing issues to supervisor's attention.
*Review accounts previously validated to ensure proper reimbursement.
Single Case Agreements
*Swiftly negotiate one time agreements to avoid interruption to the patient's care, as necessary, in accordance with Contracting's guidelines.
*Negotiate based on historical information for rate consistency.
Monitor and Report on Payor Activities
*Responsible for researching and identifying new product offerings by payor.
*Responsible for evaluating and updating appropriate materials related to payor administrative requirements.
*Responsible for communicating major payor changes to key NorthShore stakeholders.
*Responsible for updating and ensuring all internal and external insurance reference tools, such as the Pulse page tool and NorthShore.org website.
*Manages the Managed Care team's mass distribution email box.
Center of Excellence/ Bundled Payments
*Responsible for tracking of bundles cases, ensuring accurate payment and distribution of payment to hospital/surgeon.
*Responsible for maintaining and updating accurate list of surgeons to be listed in bundled payments.
*Liaison for payors to update/maintain COE status.
*Assist with facility credentialing as needed.
*Other duties as assigned.
Benefits:
*Career Pathways to Promote Professional Growth and Development
*Various Medical, Dental, Pet and Vision options, including Domestic Partner Coverage
*Tuition Reimbursement
*Free Parking
*Wellness Program Savings Plan
*Health Savings Account Options
*Retirement Options with Company Match
*Paid Time Off and Holiday Pay
*Community Involvement Opportunities
NorthShore - Edward-Elmhurst Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care,... For full info follow application link.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
