Reimbursement Job Description

Reimbursement Job Description

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Reimbursement provides support as an internal and external contact on matters related to reimbursement and therapeutics portfolio businesses including CMS-level personnel, payer medical directors and external entities that shape future landscape of health care delivery systems globally.

Reimbursement Duties & Responsibilities

To write an effective reimbursement job description, begin by listing detailed duties, responsibilities and expectations. We have included reimbursement job description templates that you can modify and use.

Sample responsibilities for this position include:

Represent HEOR on HVT franchise teams, with internal partners such as Marketing, Medical Affairs, Clinical Department, Epidemiology, Government Affairs and Policy
Identify common HTA/payer needs
Develop market access and associated clinical or economic evidence strategies
Act as business partner with HVT functions and contribute expertise to product strategies and decision making
Develop, maintain and expand health economics/HTA key opinion leader relationships
Advocate effectively within relevant physician or patient associations
Identify and collect patient-reported outcomes retrospective data analysis
Research initiatives supporting programs with identification of potential new data sources/literatures and research partners to support HE key research questions from the field, Health Technology assessment and payer relevant needs
Train and educate HVT teams on HEOR data/publications models to support therapy penetration
Resolves discrepancies and completes corrections to ensure accuracy of data, consistency, and thoroughness in billing and follow up

Reimbursement Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Reimbursement

List any licenses or certifications required by the position: AHIMA, AAPC, CPC, CCS, RHIT, CPA, FEMA, FHFMA, CMC, RHIA

Education for Reimbursement

Typically a job would require a certain level of education.

Employers hiring for the reimbursement job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Accounting, Finance, Education, Business/Administration, Business, Associates, Technical, Computer Sciences, Medical Billing and Coding, Healthcare

Skills for Reimbursement

Desired skills for reimbursement include:

Health care reimbursement from a patient and provider perspective
Government
Managed Care
Centers of Medicare & Medicaid Services
Federal payer sectors
Integrated Delivery Network/Integrated Health Systems
Private payer
Medical terminology
Medical insurance terminology
Private payer Medicare and Medicaid structure systems and reimbursement process

Desired experience for reimbursement includes:

Must be able to travel throughout Northern California with some overnight stays out of town
Must be able to adapt and work in areas while working on-site at the facility
Must be able to lift weights (5-30 lbs.) to carry workpapers files, retrieve various documents
Experience processing information, analyzing trends and making appropriate recommendations for improvement
Ability to multi-task and work with limited supervision
Familiarity with workforce management concepts

Reimbursement Examples

1

Reimbursement Job Description

Job Description Example
Our growing company is looking for a reimbursement. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for reimbursement
  • Pursue out of network exceptions on patients behalf
  • Assist in the filing of the RHCF4, Medicare nursing home cost reports and any other type of cost report that is to be filed
  • Meet with programs to help direct them with maximizing their reimbursement
  • Keep appropriate staff updated on any regulatory changes
  • Work with revenue cycle team to identify gaps in reimbursement
  • Review all accounts with payments previous day
  • Review and resolve reminder queue daily
  • File secondary, tertiary, paper claims as needed
  • Maintains established policies and procedures, objectives, quality assurance programs and safety standards
  • Participates in educational programs and inservices
Qualifications for reimbursement
  • The purpose of the role is to develop and execute reimbursement and market access strategies to support successful patient access through securing HTA recommendations favorable funding for the Heart Valve Therapy (HVT) business units in Europe
  • Bachelor’s degree in a life science, health economics, health policy, or related field required
  • A minimum of five years of Medical device or pharmaceutical related Health Economics, Reimbursement or Market Access expertise with demonstrated success
  • Influence management skills and ability to work effectively in a matrixed organization and between competing organizations
  • Experience working with customers (payers, hospitals and physicians), trade associations, professional and medical organizations and ability to develop mutually beneficial health economics and reimbursement strategies and tactics to support portfolio planning, commercialization, and sales/marketing objectives
  • The successful candidate will work across the European organization and develop strong internal and external relationships to achieve market access goals and objectives
2

Reimbursement Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of reimbursement. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for reimbursement
  • Develop relationships with payer organizations to review and discuss complex/difficult coverage cases
  • Develop standardized spreadsheets for fee schedule upload into practice management system
  • Management responsibility for all Reimbursement staff
  • Independently perform timely, accurate and complete account analysis, claim resolution and collection activity for key significant accounts
  • Monitor accounts for potential risk, develop and negotiate payment plans or other solutions on past due accounts
  • Performs cash application duties, reviewing remittance advice forms to verify proper reimbursement
  • Submit insurance claims for processing electronically or on paper to providers
  • Follow up on insurance claims not resolved within usual claim period, working with claims processors at Third Party Payer companies, regarding disputes/denied claims
  • Initiates ACR’s (Administrative Check Requests) and PO’s (Purchase Orders) for payment of departmental liabilities, patient refunds and provider overpayments
  • Review patient accounts, identifying potential adjustments for bad debt
Qualifications for reimbursement
  • Bachelor degree in Accounting, Business Administration or Finance or 7 years equivalent experience in third party reimbursement setting
  • Experience Seven years experience in Third Party Reimbursement positions, to include Medicare Intermediary experience and/or hospital reimbursement positions
  • One to three years of recent accounting or data analyst experience is required
  • Experience working with large data files in Excel or extraction of data from multiple sources into Excel or Access is preferred
  • Ability to effectively manage client relationships and project work is required
  • Ability to learn new technology applications including cost reporting software, Microsoft access and other software solutions used by the Firm to store and analyze data
3

Reimbursement Job Description

Job Description Example
Our company is looking to fill the role of reimbursement. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for reimbursement
  • Respond to inquiries from both patients and insurance companies
  • Observes legal and ethical guidelines for safeguarding the confidentiality of patient information (HIPAA)
  • Manage informational needs of multiple cross functional stakeholders to inform of reimbursement issues and/or changes
  • Act as a contact within Revenue Cycle Management Operations for payer information, payer communication and issue identification
  • Coordinate the preparation and analysis of medical education data for cost reports, monthly revenue calculations, and net revenue budgets
  • Manage duties of remote Sr
  • Planning and coordinating of third party audits and appeals
  • Maintain expertise in reimbursement regulations & strategies through appropriate education and provide education and consultation to other reimbursement staff members
  • Provide System leadership and education in area(s) of expertise
  • Review pricing request from CSRs to determine profitability based on insurance contract
Qualifications for reimbursement
  • Must have experience in healthcare, auditing, working, analyzing and completing Medicare cost reports (CMS Form 2552-96 and CMS Form 339), and Medi-Cal cost reports with related supplemental schedules (A & I Forms)
  • Bachelor’s degree in Accounting, Finance or related field with a GPA of 3.2 or higher
  • 0-3 years’ experience, preferably in healthcare, accounting or business related field
  • Travel is less than 20% and includes day trips and some overnight travel for client projects
  • Ability to plan and execute own work on time and within budget
  • Information/Data analyst education or experience preferred
4

Reimbursement Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of reimbursement. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for reimbursement
  • Participate in surveys conducts by authorized inspection agencies
  • Implement new billing program in the Triage System
  • Maintain HCPCS list as received
  • Acts as a resource to all branch personnel to resolve questions concerning reimbursement
  • Ensure patient benefits, OOP, copays are communicated, documented, and mailed to patient timely and accurately
  • Ensures accurate and current billing documentation is maintained
  • Ensures company pricing and discount policies are administered, communicated and documented correctly
  • Ensures initial data entry into Patient Care Management system is specific and accurate , Brand vs
  • Ensures re-verification of benefits occurs timely and is documented clearly in medical record
  • Monitors the performance and compliance of reporting personnel and provides feedback via performance evaluations and disciplinary action when necessary
Qualifications for reimbursement
  • 7-10 years in an LTC environment
  • Understands nursing home reimbursement as it relates to Medicaid and Medicare
  • Experience in filing RHCF4 and Medicare nursing home cost report
  • Exceptional and effective communication skills, both written and oral, for internal and external audiences at all levels
  • 5 years of clinical coding experience, either as specialist/analyst or program manager in outpatient health care and extensive knowledge of coding classification systems such as ICD-9 and ICD-10
  • Proficiency in the use of personal computers and Microsoft Office for communication and report generation
5

Reimbursement Job Description

Job Description Example
Our company is looking for a reimbursement. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for reimbursement
  • Recruits, hires, trains and supervises a competent Insurance Verification, Reimbursement Assistant, and Ship Order Staff in all aspects of the incumbent job responsibilities
  • Assists with generation of Financial Responsibility letters
  • Assists with re-verification of active patients insurance for specific payers
  • Cooperates with other staff members when planning and organizing job activities
  • Enters referrals/authorizations into computer
  • Gives high priority to duties assigned
  • Performs follow-up for authorizations/referrals not received based on branch policy and procedure
  • Willingly performs other duties as needed
  • Works with specific payers to secure required authorizations
  • Develop and negotiate reimbursement rates for new providers
Qualifications for reimbursement
  • ICD-10 or CPT knowledge and/or experience preferred
  • Bachelor’s Degree in Accounting Master’s degree preferred or Finance or other related field
  • 5 – 7 years of progressively more responsible experience in healthcare reimbursement is required
  • Working knowledge of generally accepted accounting principles and a thorough understanding of third party reimbursement mechanisms
  • Ability to communicate in clear concise terms both written and orally
  • Excellent computer skills including expertise in Excel and Access

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