Under the supervision of the Director, the Payment Review Specialist position is 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 of Hospital's 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 State and Federal regulations in order to assure compliance in payment practices.
Education and Work Experience
Minimum three years hospital billing and collection experience.
Medical and Insurance terminology essential.
Knowledge of CPT, ICD-9, HCPCS coding structures
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: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf
Prime Healthcare Systems