Reimbursement Specialist

Key Requirements:

• Commitment to advancing race (+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices
• Understanding of the impact of identity dynamics on organizational culture
• Commitment to PPSP’s In This Together service ethos, workplace values, and service standards

ESSENTIAL FUNCTIONS:

• Conduct appropriate claim follow-up on all open A/R to ensure prompt adjudication, maximize revenue and maintain the affiliate Key Performance Indicators
• Perform daily ERA, EOB, and patient payment posting as assigned
• Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates
• Follow up on denied claims with payers
• Analyze payer denial trends and payer coding requirements to ensure payment of claims
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed
• Ensure the affiliate’s claim KPIs are satisfied 
• Participate in Revenue Cycle Team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes
• Participate in cross-functional team meetings as requested to resolve problems or build workflows
• Serve as an active agent on the billing line
• Attend PPSP and PPFA training as well as other assigned training to improve knowledge base and claim efficiency
• Submit daily electronic and paper claim files, and correct all claim and charge review edits, warnings and errors; run statement files; and download ERAs/EOBs as needed
• Complete special projects as needed  


• The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.

KEY REQUIREMENTS:

• Commitment to advancing race (+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society 
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions 
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices 
• Understanding of the impact of identity dynamics on organizational culture 
• Commitment to PPSP’s In This Together service ethos, workplace values, and service standards 

QUALIFICATIONS AND EXPERIENCE:

• Required: 
• Bachelor’s degree preferred, high school diploma or equivalent required
• Three or more years’ experience in medical billing and/or Accounts Receivable
• Ability to work independently, prioritize work, and communicate effectively
• Experience with patient billing and collections
• Ability to handle confidential materials that relate to a variety of individuals, to perform well under stress and in a fast-paced environment, and to work independently. 
• Superb attention to detail with commitment to prompt, accurate customer service
• Strong problem-solving skills
• Access to secure, reliable Internet and utilities
• Proficiency with Microsoft 365 Software and use of systems
• Focus on detail orientation with commitment to prompt, accurate customer service 
• Must be able to travel to PPSP locations throughout four-county service area 
• Demonstrated dedication to Planned Parenthoods’ mission, vision and values

PREFERRED:

• Planned Parenthood experience strongly preferred

PHYSICAL/MENTAL/COGNITIVE REQUIREMENTS:

• Ability to sit for extended periods of time while working at a computer or desk.
• Manual dexterity for typing, filing and handling office equipment such as telephones and copiers.
• Occasional lifting, carrying, or moving objects up to 15 pounds.
• Visual acuity for reading documents, data entry, and viewing a computer screen.
• Ability to focus and maintain attention to detail in a fast-paced environment with frequent interruptions.
• Strong organizational and time management skills to handle multiple tasks and meet deadlines.
• Critical thinking skills for problem solving, data accuracy, and handling inquires.
• Effective communication skills, both written and verbal, for interacting with coworkers, management, and external clients.
• Ability to follow instructions, adhere to company policies, and handle confidential information with discretion.