Analyze and resolve denied healthcare claims with government and third-party payers. Identify denial trends and root causes, triage denials, manage appeals, maintain payer requirement knowledge, and recommend workflow or system improvements to reduce denials and improve collections.
Job Summary & Responsibilities Preferred Qualifications
Schedule: Mon-Fri 9am-5pm
Salary: $25.00-$26.50 / hour (DOE)
The Reimbursement & Billing Specialist is coordinates the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. The Reimbursement & Billing Specialist is responsible for prioritizing and managing to resolution denied claims with government and third party payers.
Responsibilities include:
- Interpreting payment and denial data down to the line item detail
- identifying payer and coding trends, risks, and opportunities, and to implement operational and/or systematic improvements.
- Researches, develops, and maintains a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements.
- Triages denied claims to identify appropriate action to ensure timely processing and payment.
- Performs ongoing analysis to determine the root cause of denials and proactively alert management to issues and trends.
- Proactively makes recommendations for workflow, operational, and/or systemic changes to reduce denials and speed up collections.
- Assists in developing and modifying tracking and reporting process for denials, appeals status and appeals results. Ensures that all denials are tracked and the appeals are monitored accordingly.
- Performs other duties as required.
Why Vinfen?
We are committed to you! We offer great training, great benefits, career growth and job security!
- Medical, Dental and Vision Insurance for employees working 30 hours or more
- 15 days of Vacation, 12 Paid Holidays, 10 Sick Days and 3 Personal Days per year (for employees scheduled for 20 hours or more)
- Education Assistance and Tuition Remission Programs as well as innovative Student Loan Payment Programs. Employment with Vinfen counts toward your Public Student Loan Forgiveness eligibility
- Professional Development programs including year-round online training courses and opportunities to earn CEUs
- Retirement savings programs, including a fully funded, employer sponsored retirement plan and an employee funded 403 (b) plan
- Company paid Life, Accidental Death & Dismemberment and Long-Term Disability Insurance
- Voluntary Term, Whole Life, Accident and Critical Care Insurance
- Flexible Spending Reimbursement Accounts (Health and Dependent care)
- $500 -- $1,000+ Employee Referral Bonuses with no annual cap!
- Other generous benefits including discounted memberships, access to wellness programs and more!
About Us
Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,200 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in 318 programs throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers
My Vinfen. My Community. My Job.
Vinfen is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
- 2-5 years related work experience, specifically with identifying and resolving healthcare claim denials required.
- High proficiency with Microsoft Excel required, advanced Excelknowledge preferred.
- Proficiency with other Microsoft Office products such as Outlook. Word, PowerPoint and Access
- Prior experience with 3rd party payor claim procedures (websites, systems) required.
- Prior experience with government payors (DMH, DSS) and government claims submission and reporting systems (EIM, MMIS) strongly preferred
- Prior experience with eHana, ARPlus/Hill and Waystar strongly preferred
- Certified Professional Coder (CPC) orCertified Coding Specialist (CCS) preferred.
- Must be able to successfully pass a CORI check, employment verification check, and reference check.
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