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Elevance Health

Elevance Health is fueled by a purpose to strengthen the health of humanity by redefining health, reimagining the health system, and improving communities. Reco

Audit & Reimbursement II

Location

United States

Posted

7 days ago

Salary

$57.0K - $89.7K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Audit & Reimbursement II

Elevance Health

Role Description The Audit & Reimbursement II is responsible for completing limited and full desk reviews on providers as assigned. How you will make an impact: - Performs audit work scoped by the desk reviews and will be the in-charge auditor on small and less complex audits. - Assists higher level auditor on field work and appeals as assigned. - Performs special audits of End Stage Renal Disease (ESRD) providers and provider exception requests as assigned. - Updates STAR, FISS and PSF as assigned. - Participates as a team member on audits of provider's records and other projects. - Analyzes and interprets data and makes recommendations for change based on their judgment and experience. - May perform Part A provider enrollment responsibilities as needed. - Associates in this role are expected to maintain continuing education requirements. Qualifications - Requires a BA/BS degree in Finance/Accounting/Business or any combination of education and related experience, which would provide an equivalent background. - This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years. Requirements - Degree in Accounting preferred. - Knowledge of CMS program regulations and cost report format preferred. - Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred. - MBA, CPA or CIA preferred. - If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

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Numotion is a leading mobility and rehab equipment supplier headquartered in Brentwood, Tennessee. Committed to serving its customer's lifelong needs, Numotion

Title: Reimbursement Specialist Location: REMOTE, US Tracking Code 15584-128 Position Type Full-Time/Regular Job Description: improve the lives of people with disabilities. As North America's largest provider of mobility products and services, we deliver personalized solutions from manual and power wheelchairs to medical supplies and other assistive technologies that support health, independence, and everyday participation. We're committed to a workforce of diverse backgrounds and experiences and to an inclusive environment shaped by open dialogue, attentive listening, and tangible, ongoing action. JOB PURPOSE: The Reimbursement Specialist will work to achieve cost effective accounts receivables performance as measured by payments, aging of receivables, and reduced DSO. The Reimbursement Specialist will report and make recommendations to improve applicable aspects of collections and unapplied payments, as directed by the Manager/Director. Take an active role in constantly improving the process. Communicate regularly/openly with RBC Director and other management. KEY RESPONSIBILITIES: - Responsible for the collection's accounts receivable on major accounts. - Collaborate with Billing & Collections Coordinator regarding assigned account collection activity. - Create and distribute weekly/monthly reports in required format as directed by manager. - Recommend departmental education, training needs or process improvements related to reimbursement functions to Reimbursement Managers and RBC Director. - Analyze and document trends related to payer denials, underpayments, overpayments, fee schedule changes, and BCC workflow related to unapplied deposits and other billing and collections functions. - Prepare and respond to audits/appeals within the timeframes (as dictated by the payer). - Conduct required training, as needed. - Assist/conduct new hire onboarding for Billing and Collections Coordinators. - Communicate weekly tracking and progress on appeals/audits with management. - Utilize Numotion Leadership Principles to perform the job with integrity, compliance, and values consistent with Numotion's mission. - Adhere to employee or customer confidentiality and comply with Numotion's policies and federal regulations. - Always provide excellent customer service for all internal and external customers of the operations. Provide solutions for customer concerns and continually focus on customer service as our top priority. - The above duties and responsibilities are not an all-inclusive list but rather a general representation of the duties and responsibilities associated with this position. The duties and responsibilities will be subject to change based on organizational needs and/or as deemed necessary by management. REQUIRED QUALIFICATIONS, SKILLS, AND EXPERIENCE: - High School Diploma and/or GED. - Minimum of three (3) years' accounts receivable collections experience - Minimum three (3) years' experience within health care, durable medical equipment or related capacity. - Knowledge of MS Word, Excel, PowerPoint, and Outlook. PREFERRED COMPETENCIES AND QUALIFICATIONS: - Ability to define problems, collects data, establish facts, and draw valid conclusions. - Superior communication skills, both written and verbal, to effectively address all levels within the organization. PHYSICAL WORK REQUIREMENTS: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Frequent use of hands, wrists, fingers associated with computer equipment. - Must be able to lift up to 10 pounds. - Must be able to work overtime as needed. Regularly required to sit or stand, reach, bend, stoop and move about the office. At Numotion, we offer competitive compensation packages, including medical, dental and vision insurance, short-term and long-term disability, a 401k, and life insurance. Numotion is an equal opportunity employer. We strive for a workplace that reflects the communities we serve and do not tolerate discrimination against our employees, customers, and partners regardless of ethnicity, disability, gender identity, sexual orientation, religion, age, citizenship, marital or veteran status. Numotion is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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REIMBURSEMENT SPECIALIST

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Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 35 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, and clinical outcomes in an outpatient setting. At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, and payors, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent.

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Role Description Healix Infusion Therapy is seeking a Reimbursement Specialist to join our corporate business office team! This role is 100% remote. M-F 8:30am-5:30pm. Essential Duties and Responsibilities: - Reviews aging reports with management to prioritize aged and high dollar claim resolution. - Analyze, identify and communicate trends from aging report that indicate non-payment or slow reimbursement associated with specific payors, therapies, patient accounts and/or clients. - Receives, investigates and responds to inquiries from payors. - Responsible for the follow-up of designated accounts. - Follow up on denied and short paid claims and payment errors and make applicable corrections for proper adjudication and reimbursement. - Prepare and submit appeals to overturn payor denials. - Proactively seeks resolution to billing issues that may arise and communicate findings to management and billing team. - Review claim EOBs and correspondence to resolve denials of non-paid claims. - Create Ad hoc reports as needed and distribute to requesting party. - Special Projects as assigned. - Other duties as assigned. Core Duties and Responsibilities: - Interacts professionally with clients and fellow employees. - Cooperates with team members to accomplish departmental goals. - Accepts and incorporates changes or new ideas into daily work. - Provides service in a responsive, timely and accurate manner to both clients and fellow employees. - Understands and adheres to policies and procedures. - Arrives to work as scheduled and notifies supervisors in a timely manner of any absences. - Recognizes priorities and acts; makes productive use of time. - Strives to resolve problems and conflicts on his/her own initiative. - Attempts to create new ideas or new procedures working as part of a group or individually. - As a part of your job, you will receive protected health information. It is your duty to comply with HIPAA in using and disclosing that protected health information. - Ability to remain focused, productive and available during company business hours while working remotely. - Maintain and adhere to productivity standards by providing updates of daily tasks completed to management. Qualifications - Four-year college degree preferred. - Two to three years in electronic claims submission and medical collections. - Proficiency in MS Excel. - Experience in Infusion billing and collections strongly preferred. Company Description Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 35 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, and clinical outcomes in an outpatient setting. At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, and payors, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent. Equal Employment Opportunity We are an Equal Employment Opportunity employer committed to providing equal opportunity in all our employment practices, including selection, hiring, assignment, re-assignment, promotion, transfer, compensation, training, leave of absence, discipline, and termination. The Company prohibits discrimination, harassment, and retaliation in employment based on race; color; religion; national origin; sex; pregnancy, childbirth, or related medical conditions; age; disability or handicap; citizenship status; service member status; or any other category protected by federal, state, or local law.

United States
Job Closed
Numotion logo

Reimbursement Specialist

Numotion

Numotion is a leading mobility and rehab equipment supplier headquartered in Brentwood, Tennessee. Committed to serving its customer's lifelong needs, Numotion

Role Description The Reimbursement Specialist will work to achieve cost effective accounts receivables performance as measured by payments, aging of receivables, and reduced DSO. The Reimbursement Specialist will report and make recommendations to improve applicable aspects of collections and unapplied payments, as directed by the Manager/Director. Take an active role in constantly improving the process. Communicate regularly/openly with RBC Director and other management. Key Responsibilities - Responsible for the collection’s accounts receivable on major accounts. - Collaborates with Billing & Collections Coordinator regarding assigned account collection activity. - Create and distribute weekly/monthly reports in required format as directed. - Recommend departmental education, training needs or process improvements related to reimbursement functions to Reimbursement Managers and RBC Director. - Analyze and document trends related to payer denials, underpayments, overpayments, fee schedule changes, and BCC workflow related to unapplied deposits and other billing and collections. - Prepare and respond to audits/appeals within the timeframes (as dictated by the payer). - Conduct required training, as needed. - Assist/conduct new hire onboarding for Billing and Collections Coordinators. - Communicate weekly tracking and progress on appeals/audits with management. - Utilize Numotion Leadership Principles to perform job with integrity, compliance, and values consistent with Numotion’s mission. - Adhere to employee or customer confidentiality and comply with Numotion’s policies and federal regulations. - Always provide excellent customer service for all internal and external customers of the operations. Provide solutions for customer concerns and continually focus on customer service as our top priority. Qualifications - High School Diploma and/or GED. - Minimum of three (3) years’ accounts receivable collections experience. - Minimum three (3) years’ experience within health care, durable medical equipment or related capacity. - Knowledge of MS Word, Excel, PowerPoint. Preferred Competencies and Qualifications - Ability to define problems, collect data, establish facts, and draw valid conclusions. - Superior communication skills, both written and verbal, to effectively address all levels within the organization. Physical Work Requirements - Frequent use of hands, wrists, fingers associated with computer equipment. - Must be able to lift up to 10 pounds. - Must be able to work overtime as needed. - Regularly required to sit or stand, reach, bend, stoop and move about the workplace. Benefits - Competitive compensation packages, including medical, dental and vision insurance. - Short-term and long-term disability. - 401k. - Life insurance.

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