Reimbursement Specialist (RS1) - PHMI New Jersey B.O.
Prime Healthcare Management Inc
Prime Healthcare is an award-winning national hospital system with 45 acute-care hospitals in 14 states with nearly 50,000 employees and physicians. Through a physician-directed and patient-centered model, passionate dedication to quality, evidence-based best practices, operational efficiency, technology and capital investment, our hospitals are recognized among the best in the nation. Prime Healthcare has been named a "Top 15 Health System" by Truven and our hospitals are consistently among the "Top 100 Hospitals" in the country.
Generous benefits plan: Medical, Dental, Vision, 401K
Continuing Educational Opportunities
Collaborative work teams & cohorts
...and much more!
Under the supervision of the PFS Director, the Reimbursement Specialist position is the lead responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate regulations in order to assure compliance in payment practices.
Education and Work Experience
Minimum four years hospital billing and collection experience required.
Medical and Insurance terminology essential.
Knowledge of CPT, ICD-9, HCPCS coding structures.
Experience with payment/EOB review.
Bachelor's degree preferred
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated\_files/employers/poster\_screen\_reader\_optimized.pdf
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We believe that all persons are entitled to equal employment opportunity and does not discriminate against qualified employees or applicants because of race, color, national origin, ancestry, sex, marital status, child birth or related medical condition or any other protected category as defined by State or Federal Law. We are an equal opportunity employer and do not discriminate against applicants due to veterans status, disability, race, gender or other protected characteristics.
Hospital Business Services, Inc.
Prime Healthcare Services and the non-profit Prime Healthcare Foundation employ more than 35,000 people and own and operate 34 acute care hospitals in California, Kansas, Nevada, New Jersey, Pennsylvania, Rhode Island, Texas, Alabama and Missouri. Prime Healthcare was recognized as a Top 15 Health System in the nation in 2013 and 2012. It also earned the distinction in 2009.
The Truven Health Analytics "100 Top Hospitals" award winners for Prime Healthcare in 2015 were Centinela Hospital Medical Center (fourth time), Chino Valley Medical Center (fourth time), Desert Valley Hospital (sixth time) Garden Grove Hospital Medical Center (fourth time), Paradise Valley Hospital (second time) and Shasta Regional Medical Center (third time). Six of the nine California community hospitals that earned this distinction were Prime Healthcare hospitals. Prime Healthcare hospitals have earned this recognition 33 times.
With nearly 3,000 U.S. hospitals surveyed, the hospitals demonstrated that high-quality patient outcomes can be achieved while improving efficiency. If all hospitals in the U.S. performed at the same level as the 100 Top Hospitals award winners:
•Nearly 126,500 additional lives could be saved
•Nearly 109,000 additional patients could be complication-free
•$1.8 billion in inpatient costs could be saved
•The typical patient could be released from the hospital half a day sooner
•Episode-of-illness expense would be 2 percent lower than the peer median
According to Truven the majority of the 2015 award winners have produced year-to-year performance improvement, as well. This speaks to the consistent focus on excellence by the entire organization and the men and women who serve patients.