REIMBURSEMENT SPECIALIST (ON-SITE)

JOIN THE BEST. TO BE THE BEST.

HMC Offers:

• Excellent benefits
• Quality childcare located in HMC
• Wellness Center membership
• 401(k) plan with employer match

Employee Daycare Rates

• Infants (6 weeks to 15 months) - $133 weekly, $27 daily
• Toddlers (15 months to 2 yrs) - $126 weekly, $26 daily
• 2 years to 3 years - $119 weekly, $25 daily
• 4 years to 5 years - $112 weekly, $23 daily

About the job:

A medical reimbursement specialist is responsible for organizing patient medical costs and sending invoices to collect payment from patients and their insurers. Their duties include calling patients to discuss payment and develop reasonable payment plans, entering patient data into administrative systems and recording information about outstanding claims. Additionally, the reimbursement specialist is responsible for assigning appropriate CPT and ICD-10 codes to inpatient and outpatient hospital services, along with services rendered in skilled nursing facilities, freestanding clinics, and other places of service within the HMC organization. This is not a remote position; the reimbursement specialist will be working in Hopedale.

Essential Functions/Responsibilities:

• Ensure accuracy and correct accounts, as necessary, for coding and registration errors prior to billing insurance and/or patients for services rendered.
• Daily generation of Medicare, Medicaid, and Commercial insurance claims via electronic and/or hard copy process.
• Using medical billing software, work claim edits and clearing house rejections.
• Submit billing data to the appropriate private/commercial insurance carriers.
• Manage assigned workflow to include follow up on status of claims, denials and appeals for timely receipt of payment.
• Assign appropriate CPT and ICD-10 codes to inpatient and outpatient Physician/hospital services, along with services rendered in skilled nursing facilities, freestanding clinics, and other places of service within the HMC organization, based on the legal medical record, and handwritten physician notes.
• Conduct audits and follow up on unpaid claims.
• Review explanation of benefits from insurance companies and ensure complete accurate payment posting of all monies received. This includes contractual allowances, co-pays, and coinsurance.
• Locate and send appeals for denied claims to insurance carriers with appropriate documentation and rebill as necessary.
• Work with HMC patient accounts to ensure MAPBO monies received in their department are disbursed to MAPBO accurately and timely. This will be reconciled with the compiled payment spreadsheet.
• MAPBO answers ALL billing inquiries from patients, staff, customers, and insurance companies and resolves complaints and concerns of all concerned.
• Track all surgical procedures to ensure accuracy of posting and payments.
• Review statements weekly to ensure accuracy of responsibility of balance due.
• Perform daily close at the end of the day of all monies received/charges posted are completed accurately according to billing policy guidelines and legal requirements.
• Accurately prepare daily bank deposit of all monies received.
• Work within collections software, review patient accounts for payments, make calls, and send collection notices by mail. Additionally, complete electronic submission to outside collection agency when severely past due accounts are recognized.
• Consistently demonstrate and uphold HMC's principle of providing personalized quality health and human service care for all patients all the time.
• Achieve maximum reimbursement for services provided.
• Other duties as assigned.

Hopedale Medical Complex has recognized by the Illinois Critical Access Hospital Network (ICAHN) as a 2024 Neighbors Helping Neighbors Award recipient.

HCM was recognized as:

• The Top Performer in Quality
• A Top 10 Performer for Patient Satisfaction

To learn more about us, watch our YouTube video "The Hopedale story": https://www.youtube.com/watch?v=L35LiKV1ya0

Knowledge, Skills, Abilities, and Attributes

• High School diploma or equivalent.
• Knowledge of CPT and ICD 10 coding
• One to three years of coding/billing experience.
• Comprehensive understanding of HMC policies and procedures.
• Conduct duties in a professional and timely fashion.
• Ability to exercise sound judgement.
• Ability to communicate clearly and concisely.
• Self-motivated and independently productive.
• Ability to maintain confidentiality of patient information and records.
• Ability to work effectively with employees and managers.
• Ability to convey a positive and professional image to patients and employees.
• Ability to multitask and be detailed oriented.
• Professional appearance and demeanor
• Must be willing to relocate or reside within driving distance

Background and Drug screen Disclaimer:

• All HMC employees are required to pass a Federal and State background check and pass a drug and alcohol test. We test for illegal and legal substances, including cannabis (THC).

Compensation details: 19-20 Hourly Wage

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