Lead Reimbursement Specialist - Pharmacy

Cleveland Clinic Foundation   •  

Cleveland, OH

5 - 7 years

Posted 181 days ago

This job is no longer available.

Job Details

Job Summary:

Accountable for product line billing and patient financial business systems across locations. Monitors and resolves issues pertaining to billing reports and indicators. Implements policies, procedures, and oversees reimbursement specialist within the department.

 

Job Description

Responsibilities:

  • Maintains a current level of knowledge with respect to governmental coding, billing regulations and HCFA policy across multiple departments, sections and specialties (including, but not limited to, inpatient clinics, hospital and hospital outpatient practices).
  • Monitors and resolves issues pertaining to billing reports and indicators.
  • Uses the mainframe billing applications associated with professional and technical billing across Division/Institute system locations.
  • Works closely with patients, PAS, PFS, ORM, Managed Care and primary Divisions/Institutes as well as outside organizations with regard to billing errors, patient complaints, denials, third party payer coverage and other circumstances.
  • Coordinates resources and personnel (where responsible for line management) or provides information to management for decision support at various sites.
  • Responds to Division/Institute management in the event of questions covering the financial systems.
  • Other duties as assigned.

Education:

  • Extensive CPT and ICD9 knowledge required.
  • Computer literacy required.
  • Knowledge in medical anatomical terminology required.

Certifications:

  • Certified Professional Coder (CPC) from the American Academy of Professional Coders or Certified Coding Specialist/Physician (CCS/P) from the American Health Information Management Association required.

Complexity of Work:

  • Demonstrates ability to manage clerical financial employees, understand the systems in which they interact and address the problems they encounter.

Work Experience:

  • Minimum four years CPT/ICD9 professional coding, medical billing and reimbursement experience.
  • Supervisory experiencepreferred.

Physical Requirements:

  • Manual dexterity to operate office equipment.
  • Ability to lift and transport up to fifteen pounds.
  • May require extended periods of standing, walking or sitting.
  • Good visual acuity through normal or corrected vision.

Personal Protective Equipment:

  • Follows standard precautions using personal protective equipment as required. 

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