Reimbursement Specialist-Patient Financial Services: Palomar Pomerado 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 PPH. 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. Performs other duties as assigned. Follows PPH rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, values and quality commitment of PPH.

Job Requirements