Reimbursement Specialist in Denville, NJ at Prime Healthcare

Date Posted: 7/28/2019

Job Snapshot

  • Employee Type:
  • Location:
    66 Ford Road
    Denville, NJ
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description


JOB SUMMARY: 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.


. DUTIES AND RESPONSIBILITIES 1. Reviews all contract and non-contract payments for accuracy on a daily basis. 2. Calculates contract adjustments accurately and in a timely manner. 3. Supports informational needs relating to contract negotiations and the practical application of contracts in securing appropriate reimbursement. 4. Provide the Director and Managed Care Department feedback regarding payer non-compliance with the terms of hospital contracts. 5. Review and initiate timely resolution of overpayment, underpayments, and credit balances. 6. Accurately documents EOB/RA information in the MediTech system. 7. Performs lead duties in order to insure all revenue cycle goals are met. 8. Meets cash goal requirements and all other KPI’s




  • 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

  • We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: