Description

At Legacy, our mission is to make life better for others, and we carry out that mission in everything we do. We rely on individuals who are experts in their field and who view their work as vital to the overall success of the healthcare community. Are you that type of individual?

If so, we invite you to consider this opportunity in our patient business services department as a Reimbursement Associate.

• Performs analysis of patient accounts and related analyses for assigned areas of responsibility to maximize reimbursement and minimize non-contractual and contractual allowances.  
• Ascertains and verifies business terms, relative to No Surprise Act (NSA) and contracts LHS has entered into, which may include physicians and healthplans. 
• Ensures payments are in accordance with Legacy's contracts, policies, procedures and with NSA. 
• Maintains mechanisms to ensure that contracts and NSA are properly reviewed and coded with insurance carrier for accurate reimbursement.
• Resolves denied and delinquent payment issues of complex accounts.
• Removes barriers holding up the proper payment and resolution of claims.
• Writes dispute/appeal letters to insurance companies or file appeal/dispute online for denied and underpaid accounts.
• Works closely with all available resources to resolve claim disputes including Contracting, Legal, HIM, UR, Auditing, etc.

Education:

• Bachelor's degree in business administration, or healthcare operations administration or equivalent experience required.

Experience:

• One year experience with in-depth exposure to managed care contracting with health plans required; three or more years preferred. 
• Demonstrated knowledge of Federal, State and local regulations as they relate to contracts. 
• Requires  Medicare and Medicaid knowledge.

Skills:

• Ability to facilitate decision-making among appropriate parties.
• Strong analytical and organizational and problem solving skills.
• Excellent interpersonal skills.
• Excellent oral and written communication skills.
• Excellent public relations skills and demonstrated ability to communicate in a calm professional manner.
• Excellent computer skills in the area of analysis Excel, Access, Word, Teams, Epic, E-chart software as well as report generation.
• Ability to work with a wide variety of people in a professional and effective manner.  Knowledge of Legacy policies and procedures relating to contracts preferred.
• Knowledge of online systems for eligibility and status review of claims.
• Demonstrated skills in negotiating, problem-solving, and decision making.
• Ability to adapt to change.

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