Reimbursement Program Specialist

Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer satisfaction rating. Over the years, Shield HealthCare has expanded nationally with current service locations in California, Colorado, Illinois, Ohio, Texas and Washington.

Shield HealthCare is looking for a Reimbursement Program Specialist in Valencia, CA responsible for implementing internal processes and controls that ensure compliance with new and existing regulatory requirements for the distribution of durable and disposable medical equipment and supplies. The Reimbursement Programs Specialist ensures the organization is paid correctly, reduces claim denials, and helps patients access needed medical supplies. This role requires accurate and current knowledge of medical reimbursement rules, insurance policy changes, and various medical compliance regulations.

This position is on-site in Valencia, CA.

JOB RESPONSIBILITIES:

• Partners with healthcare providers, government and advocacy agencies assigned to ensure proper program coverage and compliance
• Effectively maintains and communicates current company policies, procedures, and practices to ensure all departments have accurate, relevant information related to reimbursement programs
• Monitors regulatory agency policy changes to include research and communication of findings to internal stakeholders
• Assists in managing reimbursement related issues and policies/procedures, communicating trends and suggesting corrective actions to leadership
• Acts as a resource to the organization for payer knowledge and support
• Partners with internal departments to ensure customer orders are shipped and billed without reimbursement issues
• May act as a liaison between insurance companies, healthcare providers, and customers
• Additional projects supporting the reimbursement programs as assigned by the department leader

QUALIFICATIONS:

• 3+ years working in a Reimbursement Programs position with knowledge of medical billing/coding and insurance reimbursement processes
• Bachelor's degree in healthcare administration, public health, business, organizational management, or equivalent experience in healthcare compliance
• Proficiency in Microsoft 365 (Excel, PowerPoint, Word, SharePoint, Teams)
• A thorough understanding of HIPAA regulations, requirements, and guidelines, familiar with the privacy and security rules and how they apply to healthcare
• Ability to read, analyze, and interpret technical journals, legal documents, medical terminology, and complex documents
• Skilled in fostering collaborative relationships across internal teams and with external partners
• Excellent written and verbal communication skills
• Strong organizational skills, with extreme attention to details, the ability to manage multiple priorities, projects, respond to changing business needs, and meet critical deadlines
• Strong analytical and problem-solving skills

Pay & BENEFITS:

• $23-27/ hour
• Medical, Dental, and Vision
• 401(k) with Company Match
• Sick and Vacation Days
• Flexible Spending Account
• Life & Disability Insurance
• Education Assistance
• Employee Referral Program

Career-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer. To further enhance this tradition of excellence, our employees participate in continuous training and development programs in a variety of disciplines.

The posted range for this position is $23-27/hour which is the expected starting base salary range for an employee who is new to the role to fully proficient in the role. Many factors go into determining employee pay withing the posted range including education, prior experience, training, current skills, certifications, location/labor market, internal equity, etc.

Shield Healthcare, Inc. is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.