• Reimbursement Specialist

    Prime Healthcare (Denville, NJ)


    Overview

     

    Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

    Responsibilities

    Under the supervision of the PFS Director, the Reimbursement Specialist position is the lead responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate regulations in order to assure compliance in payment practices.

    #LI-BM2

    Qualifications

    + Minimum four years hospital billing and collection experience required.

    + Medical and Insurance terminology essential.

    + Knowledge of CPT, ICD-9, HCPCS coding structures.

    + Experience with payment/EOB review.

    + Bachelor's degree preferred

     

    Pay Transparency

     

    Prime Healthcare Management Inc offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $17.00 to $28.35. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

     

    Employment Status

     

    Full Time

     

    Shift

     

    Days

     

    Equal Employment Opportunity

     

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf

     

    Connect With Us! (https://careers-primehealthcare.icims.com/jobs/212690/reimbursement-specialist/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)

     

    FacilityPrime Healthcare Management Inc

     

    LocationUS-NJ-Denville

    ID2025-212690

    CategoryBusiness Professional

     

    Position TypeFull Time

     

    ShiftDays

     

    Job TypeNon-Exempt