Reimbursement Specialist RxPlus
at Adventist Health System

Date Posted: 3/16/2017

Job Description

Job:  Administrative / Business Support

Organization:  Adventist Health System Corporate Office

Shift:  Day

Job Posting:  Feb 15, 2017, 1:21:42 PM

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!

We are currently seeking qualified candidates for a Reimbursement Specialist position that will be based in our Rx Plus Pharmacy department.  This position is based at our Rx Plus Pharmacy in Sanford, FL.

The Reimbursement Specialist, under supervision, is responsible for maintaining the accounts receivable for both pharmacies while following the pre-established legal and financial guidelines of Adventist Health System.  The Reimbursement Specialist is also responsible for auditing insurance payer reimbursements, reconciling payments to patient accounts, analyzing payer account reconciliation discrepancies and identifying variances. Reviews assigned electronic claims and submission reports. Examines Insurance payer contracts to ensure proper reimbursement and educates team of inconsistencies in processing. Performs outgoing calls to Insurance companies to obtain necessary information for accurate billing.  Answers incoming calls from Insurance companies requesting additional information and/or checking status of billings.  Performs audits of the electronic process of posting reimbursements to patient accounts. Documents current information on account to maintain quality customer service. The Reimbursement Specialist adheres to all company policies and procedures; and adheres to Adventist Health System’s Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Specific job duties include:
  • Demonstrates through behavior Adventist Health System’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork as outlined in organization’s Performance Excellence Program.
  • Processes corporate and patient checks and denials according to contract specifications.
  • Reviews and completes monthly billing on patient accounts and makes accurate decisions to determine a follow up procedure.  Documents billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Manager if necessary. 
  • Establishes payments and coordinates flow of patient co-pay accounts in a professional manner, practicing a regard for the dignity of all patients and family members.
  • Maintains written and dated records of collection activity on accounts and documents current information on account to maintain quality customer service.
  • Works with Insurance payers to ensure proper reimbursement on patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts. Examines contract to ensure proper reimbursement, educates team of inconsistencies in processing
  • Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s).  Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts.  Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payors and patients regarding status of claim or requesting additional information.
  • Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients or insurers, as appropriate.
  • Remains in consistent daily communication with team members, including new process education, disciplinary actions, Manager regarding all aspects of assigned projects.
  • Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Manager.  Trains new staff, performs audits of work performed, and communicates progress to Manager. Provides continuing education of all team members on process and A/R requirements.
  • Maintains or exceeds monthly A/R department accountability. Provides weekly productivity reports to supervisor in a timely manner. Maintains or exceeds audit standards.
  • Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
  • Performs wide range of duties in support of the total department.  Able to handle various job tasks simultaneously. And performs general office duties.
  • Is aware of departmental changes, standards, and goals as disseminated in department meetings and complies successfully by completing assignments within designated timeframes.
  • Facilitates smooth and efficient operation of department by being available and prepared to work during scheduled working hours and attending meetings as requested by Management.

Job Requirements

Education Requirements:
  • Associate Degree in Business or Healthcare Administration
Experience Requirements:
  • Minimum of two years’ experience in Healthcare: managed care, patient financial services, finance, or contract management

If this position sounds like a great match for your skills set and experience, please apply online now!

Job Snapshot

  • Employee Type: Full-Time
  • Location: Sanford, FL
  • Job Type: Finance
  • Experience: Not Specified
  • Date Posted: 3/16/2017

About Us

About Adventist Health System

Who We Are

We are one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.

Who You Are

You are a compassionate, talented professional who wants to work in an environment where you can live out your faith and your values. You are excited about being part of a team that uses the latest technology and medical research to ensure patients receive quality care, but who also recognize that great care is always personal. You enjoy going out of your way to make each patient and their family feel special, and are passionate about guiding them toward optimal health.

Our Community

Our community is global and so is our reach. From coordinating medical mission trips in Ethiopia to planting school gardens in Florida, we are constantly seeking ways to go beyond hospital walls in improving the health of our communities. As a member of our team, you will be encouraged to use your talents in fun, meaningful ways that bring joy and healing to people around the world.

Our Mission

Part of this worldwide network, Adventist Health System was founded in 1973 to support and strengthen the Seventh-day Adventist health care organizations in the Southern and Southwestern regions of the United States. Today it is a national leader in quality, safety and patient satisfaction, comprised of 46 hospital campuses and nearly 77,000 employees.

Although separated by geography, each of our facilities is united by the mission of Extending the Healing Ministry of Christ. Today we continue the tradition of whole-person care by practicing and sharing CREATION Health, a blueprint for living a healthy, happy life based on the principles given in the Bible’s creation story: Choice, Rest, Environment, Activity, Trust, Interpersonal relationships, Outlook and Nutrition.

We provide comprehensive benefits, training and advancement opportunities. We care for our employees as well as we care for our patients.