Search Firm Looking For Person With Medicare Experience

(CONTACT JANINE PAPPENFUSS AT SC CAREER SERVICES)


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From: Jenkins Consulting Group, LLC [mailto:cjenks@vcn.com]
Sent: Wednesday, November 21, 2007 11:38 AM
To: Janine Papenfuss
Subject: PappenfussJ ET re Reimbursement Specialist 112107



Dear Janine,



Thank you so much for the return phone call Janine. Below please find a job description for a Reimbursement Specialist. A client I am working with has an immediate need to fill this position. The job is located in the suburban Chicago area.



The client also has an immediate need for some consulting assistance with testing a claims payment information system used to process Medicare claims according to fee for service methodology. The consulting work would be to develop various claims scenarios to test the IT system and processes to verify the financial and procedural accuracy of claims processing. The ideal consultant would have very recent Medicare FFS claims processing experience having worked for a carrier or fiscal intermediary or consultant to a carrier or intermediary. Detailed knowledge of Medicare prospective payment systems is required. Some travel to the Chicago area would be required. Approximate engagement time would be now and most likely through the first quarter of 2008.



If you have any candidates, please have them contact me at 320-363-7880.



Again, thanks so much!



Carol Jenkins



GENERAL PURPOSE OF THE JOB: The Reimbursement Specialist will be responsible for accurately, and in a timely manner, responding to all reimbursement issues as requested by the provider community. The position will be responsible for keeping current with Medicare reimbursement policies and procedures. It will also play an active role in the development of educational materials for providers.



SUPERVISORY RESPONSIBILITIES: None



ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.



- Consistently updates knowledge of regulations, procedures and standards pertaining to Medicare claims payment to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities.

- Responds to all provider inquiries relating to Medicare claims submission and payment.

- Contributes to the development and dissemination of claims submission educational materials to support the improvement of provider claims submittal

- Contributes to the development of provider educational presentations which will include bulletins, newsletter articles and distribution pieces.

- Will support the Manager of Contracting by updating trends in types of calls/requests, changes in Medicare payment regulations, etc

- Troubleshoot payment obstacles of government programs. Resolves issues or confers with Manager to achieve solutions.

- Work with Contract Manager to implement and maintain written policies and procedures



MINIMUM QUALIFICATIONS

(Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required):



- College degree or equivalent with minimum five years experience in Medicare reimbursement

- Understands Medicare billing/coding and has experience with ICD9, CPT, HCPCS, RVU, DRG, and APC

- Experience with CMS 1500, UB04 and electronic claims submission

- Understanding and compliance with HIPPA regulations

- Ability to access and navigate CMS website data i.e., Federal Register, Medicare policies, etc.

- Knowledge of Medicare reimbursement models

- Ability to think strategically

- Strong customer relations skills

- Goal and team oriented

- Experience with dual-payer relationships

- Computer literate, experience with Word, Excel, PowerPoint and Access

- Ability to handle ever changing fast-paced environment

- Excellent written and oral communication skills



ESSENTIAL BEHAVIORS AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION:

• Commitment to values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment & Fun with ability to demonstrate those positively and proactively to patients, co-workers, management, physicians, and/or vendors.

• Must have excellent communication skills with the overwhelming desire to customer satisfaction.





LANGUAGE SKILLS:

Fluent in the written and verbal skills necessary to perform successfully the essential functions, duties, and responsibilities of the position.



Vision requirements.

Vision adequate to perform essential duties and responsibilities of position.



PHYSICAL DEMANDS

Physical requirements can vary. These must be reviewed with management. However, in general, the position requires the following physical activities:



None





WORK ENVIRONMENT

Typical office noise environment.