Shift: Full time, Days

Reporting to the Patient Accounting Supervisor/Manager for that area, the Billing Reimbursement Specialist is responsible for ensuring that all assigned third-party accounts are reviewed and that all payers remit payment in a timely manner. Ensures all eligible accounts are appealed within the designated payer timeframes and documented appropriately in the patient accounting system. Coordinates the transfer and communication of accounts with insurance balances to the appropriate outside agency.




1. Reviews aging reports or work lists in hospital related billing system(s) to identify accounts in need of follow up. Drafts and submit letters and reports in accordance with departmental policy and procedures. Monitors payments for accuracy and timeliness and reports ongoing issues to Supervisor. Ensures claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims. Responsible for meeting account targets, error ratios, and reporting requirements. Monitors month-end metrics and baseline variances and provides explanations to leadership when appropriate.

2. Resolves claim edit errors and issues identified in the Claim Edit work queues, tracks and trends and inform Manager/Supervisor.

3. Contacts employers, insurance carriers, Medicare/Medicaid, and other parties for interpretation of coverage and benefits. Contacts identified payer sources, accessing and navigating third-party portals via websites and phones, to research and resolve problems or issues with payments and transmits required documentation to government and third-party payers for the purpose of resolving payment issues. Ensures payer contacts are fully documented in the appropriate software application. Serves as a point of contact for third-party payers and vendors/external agencies.

4. Executes the denial appeals process to resolve appeals with third-party payers. Provides on-going feedback to Supervisor identifying root causes for denials, appeals, and managed care contractual requirements. Maintains data on the types of claims denied and root causes and collaborates with team members to make recommendations for improvement and issue resolution. Addresses and resolves denied accounts ensuring payments are made accurately, in full per contractual agreements. Recommends accounts for contractual or administrative write-off along with appropriate justification and documentation.

5. Analyzes explanation of benefits, letters from attorneys and requests for additional claims data. Analyzes accounts for insurance payment accuracy and completeness and payer claim processing accuracy. Collaborates with credit specialists on overpaid accounts and utilizes industry and regulatory guidelines for collection of outstanding accounts.

6. Ensures existing quality and productivity standards are met. Contributes to the overall team effort of achieving the department accounts receivables goal and cash collection. Assists in identifying opportunities for system and process improvements.

7. Adheres to all Northwest Community Hospital standards, policies and procedures.

About Us
Serving Chicago's northwest suburbs since 1959, we are an independent, not-for-profit healthcare system dedicated to providing outstanding care in the communities we call home. Our comprehensive, patient-centered system of care has dozens of locations throughout the area.
Our award-winning care has been recognized on a national level. Some of our top awards include: