NI-Specialist, Reimbursement

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

10/10/2025

Entity:

Illinois

Job Code:

NI-4050HH

Job Title:

NI-Specialist, Reimbursement

Exemption Status:

Non-Exempt

JOB SUMMARY

Responsible for a variety of billing, intake, insurance investigation, collections, and accounts receivable.   Provides customer service support to  Home Infusion, resolves problems and answers patient and colleague questions.  Inputs patient and physician data into home infusion software. The Reimbursement Specialist is responsible for a portfolio of accounts and working through the entire intake and billing cycle from charge review, claim submission and follow-up. Participates in continuous quality improvement activities and educational experiences in support of departmental philosophy and objectives, as well as Health System initiatives.

MAJOR RESPONSIBILITIES

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Maintains a timely and accurate billing system for Agency following established procedures.

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Posts revenue and cash to Accounts Receivable computer system daily following established policy. Maintains spreadsheet for recording deposits.

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Process delivery tickets, verifying billed amounts and coordinating discounts, rates and charges and computing contractual allowances for patient bills in accordance with Agency guidelines.

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Utilizes computer system to submit claims electronically.

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Mails first, second and third notices to past due accounts and letters of patient responsibility per policy.

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Collects overdue accounts and utilizes aging report to monitor and follow-up on past due accounts in compliance with Agency guidelines. Establishes suitable payment arrangements in accordance with agency guidelines.

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Investigates credit balances on patient accounts and issues refunds according to agency guidelines.

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Performs insurance verification on accounts and document findings according to established procedures.

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Audits all Medicare and Public Aid accounts in accordance with agency guidelines.

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Performs month end procedures and creates reports in home infusion software

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Field secure chat, CC notes, workqueue, fax and phone referrals to determine patient eligibility, network status, and pharmacy capability.

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Completes thorough intakes of all pending and confirmed patients

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Verification of insurance benefits, submission of authorizations as needed. Complete calculations on potential self-pay balances.

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Conduct pre-admission phone called with patient for Home Environmental Assessments as well as providing patient with up front or post insurance costs.

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Track yearly Therapy Consent forms for renewals as needed for Medicare and Joint Commission requirements.

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Monitor potential referrals from UW Northern IL Hospital

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Answers incoming calls to the department and triages appropriately.

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Answers patient phone calls for enteral refill requests, confirms current supply list and verifies any changes

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Assists pharmacy staff with daily tasks.

ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.

X

Non-Clinical

JOB REQUIREMENTS

At least two years billing experience required with an emphasis on Public Aid, Medicare, DME, Infusion and Home Health Care.

Preferred

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Proficiency in a variety of computer applications and common office equipment.

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Ability to type 40 wpm and to utilize 10 key punch machine.

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Working knowledge of Medicare and third party payors preferred.

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Knowledge of medical terminology.

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Excellent organizational, communication, attention to detail and follow through skills.

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Successful completion of annual job specific competencies and skill verification tools required.

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Maintains confidentiality of sensitive information.

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Excellent oral and written communication.

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Ability to react to frequent changes in duties and volume of work.

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Ability to manage multiple tasks with ease and efficiency.

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Basic math skills.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

30 - 50 lbs.

X

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.