Reimbursement Specialist

The Reimbursement Specialist is responsible for managing and ensuring the accuracy and timeliness of Medicare cost report acceptance, tentative and straight-to-final settlements, interim rates, and applicable limits for all providers in the Fiscal Intermediary Shared Systems (FISS). This position plays a vital role in securing proper reimbursement for Medicare healthcare providers.

Key Responsibilities

• Process cost report correspondence, including mail, cost report submissions, and settlement documentation (tentative and final)
• Analyze cost report documentation to determine whether acceptability criteria are met for submission
• Update systems such as FISS and STAR with application data from Provider Enrollment
• Maintain system accuracy by updating rate changes based on payment rate reviews, provider reviews, and CMS-mandated changes
• Build constructive working relationships with internal teams, clients, and customers to meet shared goals
• Collaborate with departments such as Recoupment, Systems Support, Provider Call Center, Provider Audit, Provider Enrollment, PreProcess, and Provider Education to resolve provider issues
• Respond to provider inquiries regarding payments, cost reports, and reimbursement-related topics
• Mentor and support onboarding and development of new and existing staff
• Collaborate with team members to achieve departmental goals and ensure timely task completion
• Contribute to a positive team environment through feedback, process improvement, and participation in team goals

Required Qualifications

• High school diploma
• At least 1 year of experience accounting, or healthcare
• Strong data entry accuracy
• Demonstrated problem-solving skills

Preferred Qualifications

• 2 years of experience in accounting or healthcare
• Effective oral and written communication skills
• Strong time management and customer service orientation
• High attention to detail and accuracy
• Strong critical thinking and analytical abilities

• Impactful Work: Contribute to Medicare compliance and provider reimbursement, ensuring proper healthcare funding.
• Professional Growth: Gain exposure to complex reimbursement models and regulatory compliance in a dynamic healthcare environment.
• Collaborative Team: Work with industry experts in a supportive, team-oriented culture.

Benefits: 

• 401(k) 
• 401(k) matching 
• Dental insurance 
• Disability insurance 
• Medical insurance 
• Life insurance 
• Flexible Paid time off (FPTO) 
• Paid Holidays 

Background Check Process:

• Education, Employment and Criminal (local, federal), 7 years' work history
• Drug screen
• Fingerprinting for Personal Identity Verification (PIV) Card
  • Subject to additional background investigations conducted by the Defense Counterintelligence and Security Agency. 
  • Must be eligible, and obtain a PIV card .