Job details
Salary $13.98 - $23.00 an hour job type full-time
Full job description
* position is eligible for remote / work from home opportunity *
Department: provider audit
Telecommuting: yes
Paygrade: n12
Job title
Reimbursement specialist
Job summary
The reimbursement specialist is responsible for the management, accuracy, and timeliness of medicare interim rates and applicable limits for all providers in the fiscal intermediary shared systems (fiss)This position updates and analyzes centers for medicare & medicaid services (cms) correspondence and reviews applications for extended repayment plans.
Key performance indicators
Maintains accurate medicare interim rates and limits
Accurate data entry updates in accordance with fiss and cms standards
Excellent customer service
Essential functions
Key duties/responsibilities/accountabilities
Maintains a log of providers to ensure interim rate reviews are completed timely
Reviews payment rates for prospective payment system (pps) providers receiving pass-through payments, federal qualified health center (fqhc) per visit limits, cost-reimbursed providers daily per diem, and providers on periodic interim payments (pip)
Prioritizes provider requested reviews
Utilizes system for tracking audit and reimbursement (star), fiss, provider statistical and reimbursement system (ps&r), healthcare integrated general ledger accounting system (higlas), and work paper manager (wpm) operating system during rate review
Prepares documents that support the final interim rate, including the system screen prints, provider submitted work-papers, ps&r reports, lump sum data, and team supervisor approved cover sheet
Updates processes as cms mandates
Reads, analyzes, monitors, and implements cms correspondence for provider audit and impact on audit
Monitors upcoming assignment deadlines in cms correspondence, including making assignments, providing feedback, and submitting coversheets
Works with auditors, team supervisors, and managers to ensure all cms correspondence items are accounted for and communicate effective with cms/noridian inter-department staff
Performs analytical reviews of extended repayment (erp) and accelerated payment requests
Applies the internet only manual (iom) and code of federal regulations (cfr) criteria to the review and analysis of providers wanted to extend their repayments or receive early payments
Ensures all required financial statement, bank information, payment history, and payment files are utilized accurately in determining erp
Ensures cms receives our recommended accelerated payment requests in a timely matter for those providers needing payment due to circumstances outside their control
Ensures provider audit overpayment staff monitor the approved erp or accelerated payments
Tracks and follows-up on unresolved erp applications for cms deliverable
Assists in general administration of the medicare program by interpreting and implementing medicare regulations, meeting cms mandates and deadlines, training new staff, and resolving reimbursement issues
Contributes positively to a team-based work environment by actively seeking and providing feedback, participating in team and divisional goals, and streamlining and improving processes
Non-essential duties and functions
Other duties as assigned
Attends training courses/workshops
Minimum qualifications
Associates degree in accounting or business-related field or equivalent work experience
3 years` applicable work experience
Preferred qualifications
Above requirements and the following:
Bachelor`s degree in accounting or business-related field
Medicare cost reporting experience
Advanced knowledge and proficient use of medicare cost reporting systems, fiss, higlas, star, and wpm
Working knowledge of medicare regulations and reimbursement principles
Knowledge of various software packages (star, word, outlook, excel, access, and powerpoint)
General healthcare knowledge
Effective oral and written communication skills
Good organizational skills
Maintain quality and quantity of work products
Meet department production and quality requirements
Environment and cognitive/physical demands
Office environment
Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
Requires prolonged sitting and telephone use
Requires the use of office equipment such as computer terminals, telephones, copiers and printers
Infrequent lifting to 15 pounds
Infrequent stooping
Segregation of duties
Every employee is responsible to perform their duties and responsibilities in accordance with noridian values, policies and procedures, including but not limited to: segregation of duties principles, hipaa, security and privacy, cms requirements, the noridian compliance program and any other applicable laws, rules and regulations.
Statement of other duties
This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functionsEmployees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total rewards package:
Health, dental and vision insurance, voluntary insurance plans, health savings and flexible spending accounts, 401k and company match, company-paid life insurance, education assistance program, paid sick leave, paid holidays, increasing pto accrual plan, medical/parental/disability leave, workers compensation, retiree benefits, severance package, employee assistance program, financial and health wellness benefits, casual dress, open office setting, and online learning system.
Cms access compliance and regulation contingency statement
Some positions require compliance with (i) federal and agency specific regulations and related clauses included in noridian`s prime contracts with the government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal employment opportunity
Equal opportunity employer of minorities, females, protected veterans, and individuals with disabilities as well as sexual orientation or gender identity.
Notice to colorado applicants:
Per colorado’s equal pay transparency rules act, below is the salary range for potential new hires that will be
Working/residing in the state of colorado.
Colorado salary range: $13.98– $23.00
Other compensation: incentive plan
Other information
Job posting policy 6.05: new employees with noridian healthcare solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day reviewFor positions outside their department, they must attain a minimum of six months of service before they can apply.
This job will be closed 10/08/0000 at 8:00am cstNo further applications will be considered.
Equal opportunity employer/protected veterans/individuals with disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicantHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor���s legal duty to furnish information41 cfr 60-1.35(c)
