Reimbursement Specialist

Your experience matters

At UP Health System - Marquette, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

About Us

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. UPHS - Marquette is a 222 bed hospital in Marquette, MI and houses the region's only Level II Trauma Center and Neonatal Intensive Care Unit (NICU). We also provide outreach with programs like annual health and safety fairs, health screenings for the entire family and more to keep our community healthy!

In Marquette our fascinating history, rural landscape, abundant recreational opportunities, and welcoming people make the Upper Peninsula someplace special. From a thriving culinary scene to charming shops to historic lighthouses and museums, there is something for everyone in this beautiful lakeside gem.

How you'll contribute

The Reimbursement Specialist reconciles and posts all payments received, identifies discrepancies and analyzes issues to ensure payments are posted timely.

Qualifications and requirements

Minimum Education
High school diploma
Current Coding Certification
College degree in Business/Finance preferred

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Minimum Work Experience
3-5 years in medical billing
Knowledge of business functions
Familiar with collection procedures
3-5 years supervisory experience preferred

Essential functions:

• Maintains established hospital and departmental policies and procedures, objectives, performance improvement program, safety, environment of care, management of information, and infection control standards
• Review and validate adjustments to accounts based on insurance reimbursement, coverage, contracts and services provided.
• Analyze and reconcile denied payment transactions.
• Audits payments from 3rd party payers for compliance with contracted amounts.
• Assists with the preparation and maintenance of department reports.
• Prepares periodic reports for senior management, as delegated by the director.
• Works closely with clinical staff, physicians, other department stakeholders, patient accounting and scheduling areas
• Reviews charges for correct coding, completeness and accuracy of demographic and insurance data.
• Prepares specific financial reports as assigned.
• Reviews claim pertaining to billing, authorization, coding and documentation requirements. When necessary implements action plans to prevent denials and rejection recurrence with Directors approval.
• Coordinates various R1 processes to ensure expeditious billing performance.
• Demonstrates effective problem-solving, an ability to communicate verbally and in writing and a willingness to adapt to changing environment.
• Maintains working knowledge of the flow of information that supports the billing process, including medical documentation, CPT, HCPCS, ICD, MSDRG and other applicable documentation required for compliant billing.
• Assists in investigation, documentation and resolution of various input and output computer application problems as identified and reported by audit reports, computer vendors, Information Technology or support personnel as necessary.
• Promotes and maintains positive working relationships within the department and with other areas throughout UPHS-M, the community and outside agencies.
• Demonstrates professionalism with fellow employees, providers, and patients in person, on the telephone, and in writing.
• Demonstrates by his/her own behavior a strong sense of commitment to patient care.
• Demonstrates respect for individual dignity and diversity.
• Coordinates with other departments within the organization in a collaborative environment to ensure appropriate billing procedures are in compliance with third party payers, federal/state law and accrediting/licensing agencies.
• Maintains and fosters effective public relations with patients, staff, partners and the public.

EEOC Statement

UP Health System - Marquette is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.