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Independent Health · 1 month ago

Network Reimbursement Specialist-Associate

Buffalo, NY (14221)

Full-time

Hybrid

Entry Level

$20/hr - $22/hr

1+ years exp

Independent Health is an organization focused on fostering growth, innovation, and collaboration among its employees. The Network Reimbursement Specialist-Associate will ensure adherence to policies and processes supporting physician and provider agreements, while also handling claim procedures and supporting claim processing. This role involves participating in work groups to assist in corporate reimbursement objectives.

Health CareInsuranceNon Profit

No H1B

Responsibilities

Assist in the timely review and manual adjudication of professional claims through claim queues; meeting agreed upon key performance indicators for output with a high degree of accuracy

Assist in the timely review of weekly, monthly, and/or quarterly claim reports to support network reimbursement workflows

Understand Independent Health reimbursement policies and standard operating procedures and independently apply that to manual claim adjudication

As directed, assist with the triage and maintenance of the professional fee request process

Assist in updating the corporate Participating Provider Reimbursement Manual

Assist in the maintenance of team meeting agendas and minutes as well as manage workflow volumes and turnaround times for the team

As directed, actively contribute to or participate on team meetings and discussions as well as collaborate with other team members on assigned projects

Assist in the establishment of standard operating procedures consistent with correct coding and billing guidelines or as defined by Independent Health policy

As directed, assist Network Reimbursement Professionals and Management with matters of professional reimbursement or process implementation

Assist in the tracking and maintenance of reimbursement policies

Establish process to continue to grow knowledge of industry standards related to reimbursement methodologies, billing practices and coding rules

Qualification

Healthcare experienceClaims processingCPTICD-9-CMICD-10-CM codingCertified Professional CoderAnalytical skillsEffective communicationTeam collaboration

Required

High school diploma or GED required

One (1) year of healthcare experience in claims, billing and/or reimbursement required

Understanding of industry standard claims edits and correct coding requirements required

Current certification of Certified Professional Coder, American Academy of Professional Coders or will be required to obtain certification within (1) one year required

Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding systems

Strong analytical skills

Ability to assume responsibility and accomplish daily tasks with little to no direct oversight

Effective written and verbal communication skills

Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable

Preferred

Associates degree preferred

Benefits

Scorecard incentive

Full range of benefits

Generous paid time off

Company

Independent Health

As one of Western New York's first HMOs, Independent Health covers approximately 355,000 people here and across the country with more than 100 plans, services and products.

Founded in 1980

Williamsville, Virginia, USA

1001-5000 employees