Reimbursement Specialist

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Job Summary:

The Reimbursement Specialist reports directly to the Manager of the Wellstar Revenue Cycle area Key responsibilities of the role include: Performing high volume and high dollar account review Cross training on other service lines and supporting internal team members when needed to cover shifts or special projects Communicating regularly with other Wellstar revenue cycle departments, facility and vendor staff and leadership, to complete daily work Reviewing charts following strict HIPAA guidelines Validating accurate charge capture, billing, payment posting, and adjustments as indicated by revenue cycle area Resolving Epic Workqueue tasks, including, but not limited to, registration review, charge review, payment review, adjustment review, claim edits and denials. In some areas, responsibilities include payment posting, making recommendations for adjustments, balancing to the bank. Other duties as assigned by Revenue Cycle area Manager, Director, and Executive Director Impact of this role in the organization: Ensures accurate revenue cycle postings for maximum adjudication of special high dollar and volume billing programs Contributes to Revenue Cycle area's departmental goals of compliance and valid chart to transaction representation

Core Responsibilities and Essential Functions:

Account Review and Modification * Charge review and correction to ensure accurate billing and reimbursement downstream * Charge review and correction to resolve account errors, claim failures, and resolve denials, following Government and Managed Care guidelines Information Gathering, Distribution and Analysis * Data retrieval from other departments within Revenue Cycle * Run various Epic reports to gather information and aid in task completion * Review account payer and patient demographics * Utilize HIPAA-protected patient financial and medical records to make charge correction decisions Customer Service * Work with internal and external customers to resolve account issues and expedite downstream adjudication. * Provide detailed information to leadership to address escalated issues Special Projects and Shift Coverage * Cross train on other service lines within Revenue Cycle area * Assist Senior Reimbursement Analysts, Auditors, and leadership with data entry and/or special projects Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High school diploma Required and Associate's Degree Preferred or Bachelor's Degree Preferred and Hospital Billing and Coding technical education/certification/diploma Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 3 years Revenue Cycle experience, to include exposure to professional or institutional back office processes such as charge posting, medical record review, claim failure review, insurance follow-up and denial resolution. Required and Data entry experience. Required and Epic experience Preferred

Required Minimum Skills:

Self-motivated and able to work independently. Ability to communicate professionally with the healthcare team across the organization. Ability to use EXCEL, Word, Outlook, Teams (or similar collaborative application). Working knowledge of revenue codes, HCPCS, CPTs, billing and reimbursement methodologies for government and commercial payers.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.