Reimbursement Specialist

The underpayment specialist is responsible for payment variance activities related to the incorrect processing of claims. Responsibilities include: validating underpayment variances and taking appropriate resolution steps, tracking underpayment recoveries, trending underpayments by payer and issue and successfully recovering underpaid amounts as efficiently as possible. Working under the direction of the Reimbursement Manager, the Underpayment Specialist to assist in troubleshooting system proration problems, payer issues and contract-related discrepancies. Variances are referred to the Underpayment Specialist via an underpayment work queue that calculates payment variances against expected reimbursement.

Education & Experience:

• High School diploma or equivalent
• 2 years hospital or physician revenue cycle or contracting experience required or 2 years experience working for a health plan in a capacity that pays claims and/or reviews contract terms.
• Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting.
• Excellent ability to understand contract terms and calculate reimbursement.
• Knowledge of the principles of Information Systems in order to effectively collect on underpayment variances.
• Excellent written and oral communication skills to effectively communicate with payors and other departments
• Knowledge of healthcare related financial and/or accounting practices
• Ability to manipulate data using excel.
• Ability to deal effectively with constant changes and be a change agent.
• Detailed knowledge of health plan operations, reimbursement methodologies, payer contracts and clinical policies
• Knowledge of state, federal and compliance regulations as they pertain to coding and billing processes and procedures.
• Prior experiences with Epic Systems Revenue Cycle Solutions preferred

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.