Reimbursement Specialist II

Department

Revenue Cycle
Job Summary

Provides administrative support responsible for accurate and timely posting of Surgery, Emergency Room (ECC) charges for either SMHCS or North Port, hospital wide observation charges, or Delivery/High Risk Antepartum/Testing/Triage charges, under the direction and supervision of Revenue Cycle Management. Provides compliant charging practices for all payors by reviewing the medical record for appropriate clinical documentation that supports the accuracy of charges. Independently resolves Surgery, Emergency Room, Observation, or Delivery/ High Risk Antepartum/Testing/Triage charge Correct Coding Initiative (CCI) edits. Performs other reimbursement assignments to resolve billing, coding, or collection issues. Interacts with clinical staff to educate and improve clinical documentation that supports the accuracy of care provided and charges posted. Assists Revenue Cycle staff in providing information to support appeals or audits. Acts as a leader, mentor, and trainer to other Reimbursement Specialists.

Required Qualifications

- Require a minimum of four (4) years of health care experience involving charging practices and patient flow processes.
- Require coding certification.

Preferred Qualifications

- Prefer clinical certification from a recognized health care credentialing organization in a specialty area (i.e. RRA, RT, VI, CI, RCIS, RVS, SCFA and CST).
- Prefer demonstrated interpersonal and communication skills.
- Prefer working knowledge of commonly used computer applications.
- Prefer the ability to work with minimal supervision.
- Prefer demonstrated proficiency with medical terminology.
- Prefer demonstrated proficiency with specific charging and coding as it applies to various departments (i.e. Surgery, Emergency Room, Observation, or Delivery/High Risk Antepartum/Testing/Triage).

Mandatory Education

HS EQ: High School Diploma, GED or Certificate

Preferred Education

Required Licenses and Certifications

Preferred Licenses and Certifications

Employment Screening Requirements

As part of Sarasota Memorial Health Care System’s commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/

- Prefer clinical certification from a recognized health care credentialing organization in a specialty area (i.e. RRA, RT, VI, CI, RCIS, RVS, SCFA and CST).
- Prefer demonstrated interpersonal and communication skills.
- Prefer working knowledge of commonly used computer applications.
- Prefer the ability to work with minimal supervision.
- Prefer demonstrated proficiency with medical terminology.
- Prefer demonstrated proficiency with specific charging and coding as it applies to various departments (i.e. Surgery, Emergency Room, Observation, or Delivery/High Risk Antepartum/Testing/Triage).

- Require a minimum of four (4) years of health care experience involving charging practices and patient flow processes.
- Require coding certification.