Adventist HealthCare · 3 months ago
Reimbursement Specialist (Hybrid), Day Shift, Patient Financial Services
Gaithersburg, MD
Full-time
Hybrid
Mid Level
$20.51/hr - $27.21/hr
3+ years expAdventist HealthCare is a faith-based organization dedicated to providing high-quality healthcare in the Maryland area. They are seeking an experienced Reimbursement Specialist for their Patient Financial Services department to manage and resolve billing claims and ensure timely payments from payers.
Health CareHome Health CareHospitalNon ProfitRehabilitationWellness
Responsibilities
Establishes the payment status of billed or partially paid claims
Determines the root cause of a denial or partially paid claim
Contact the payer either by phone call or online payer portal to determine if the payer is requesting additional information in order to adjudicate the claim
Obtain payment or commitment from the payer to pay
Obtains status on billed, resubmitted, appealed and reconsideration claims
Determines if the claim is on file
A file appeal after review of a denial indicates an appeal is needed or the payer agrees to reprocess the claim
Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed
Contact payer either by phone call or the online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication
Routes the denial to the appropriate team after denial has been determined that another department should resolve
Routes claim to the biller only when no claim is on file after review of the bill scrubber acceptance report
Transfers the unpaid balance to the patient once patient responsibility has been determined
Review the Explanation of Benefits for clarity
Processes payer changes as needed
Qualification
Required
High School Diploma required, or some college preferred
A minimum of 3 years' experience within a healthcare environment can include an insurance company, a public health setting, or an outsourcing company
Frequent pressure due to time constraints
Frequently works at a PC involving focused concentration
Frequent walking, standing, bending, kneeling/crouching, sitting etc
Light physical effort (lifts or carries up to 10lbs)
Atmosphere and environment associated with an office setting
Must maintain a professional appearance and demeanor at all times
Benefits
Work life balance through nonrotating shifts
Recognition and rewards for professional expertise
Free Employee parking
Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
Paid Time Off
Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
Subsidized childcare at participating childcare centers
Tuition Reimbursement
Employee Assistance Program (EAP) support
Company
Adventist HealthCare
Adventist HealthCare is an integrated, health-care delivery organization.
5001-10000 employees
H1B Sponsorship
Adventist HealthCare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (25)
2024 (11)
2023 (6)
2022 (23)
2021 (15)
2020 (12)
Funding
Current Stage
Late StageLeadership Team
Joseph Tucker, CPA
Vice President and Chief Financial Officer
Seleem Choudhury
Chief Operating Officer
Recent News
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