Reimbursement Specialist

Job Overview

The City of Racine is seeking a dedicated Reimbursement Specialist to assist the Public Health Department by conducting various financial, clerical, administrative, and technical duties. This position is based in Racine, WI, and involves processing claims, financial reporting, and supporting special projects while maintaining the integrity of accounting data.

Key Responsibilities

• Manage patient billing, claims, reimbursements, and revenue transactions ensuring accuracy and compliance.
• Investigate and resolve denied, rejected, or delayed claims and maintain reimbursement records updating client accounts accordingly.
• Ensure adherence to HIPAA, Medicaid, legal, regulatory, and medical coding standards; communicate updates to team members.
• Handle provider portals, revalidations, medical records, account databases, and generate necessary reports.
• Assist clients with intake, eligibility screening, licensing, referrals, and connecting to community and social services.
• Prepare correspondence, contracts, reports, grant documentation, and other confidential records ensuring data integrity.
• Conduct cash handling including payment processing, transaction reconciliation, deposits, and financial record maintenance using MUNIS software.
• Monitor grants and contracts to verify compliance with objectives, deliverables, reporting, and funding requirements.
• Deliver customer service by responding to inquiries, resolving issues, and explaining departmental policies and procedures.
• Support department operations through cross-training, staff education, quality assurance measures, emergency response coordination, and consistent attendance.

Required Qualifications and Skills

• Associate's degree in accounting or related field with at least three years of responsible accounting experience or equivalent training.
• Three or more years of office and system support experience, ideally in healthcare or a related environment.
• Valid Wisconsin driver's license and reliable insured vehicle.
• Current CPR/AED/First Aid certification or ability to obtain within six months.
• Proficient knowledge of HIPAA privacy standards and patient/client confidentiality.
• Competency in Microsoft Office suite (Word, Excel, Outlook, PowerPoint, Publisher) and experience handling large and specialized databases.
• Ability to analyze and manipulate data to interpret significance and outcomes.
• Strong communication skills, both oral and written, using proper grammar and professional interaction with diverse stakeholders including clients, physicians, and government officials.
• Ability to interpret and enforce relevant state, local, and federal regulations.
• Physical capability to perform duties which may include standing, sitting, walking, stooping, bending, lifting (up to 35 pounds), and typing.

Preferred Qualifications

• Certification such as Certified Professional Coder (CPC), Certified Coding Associate (CCA), or Registered Health Information Technician (RHIT).
• Experience working within governmental public health agencies.
• Knowledge of third-party and Medicaid billing regulations.
• Bilingual abilities especially in Spanish and English.
• Customer service experience and familiarity with diverse racial and ethnic groups.
• Advanced skills with Microsoft Office and public speaking proficiency including the presentation of data using PowerPoint.

Additional Information

The City encourages applications from Racine residents who will receive a 4% pay differential atop the hourly wage. The position supports a workforce reflective of the community served, offering equal employment opportunities and accommodations under the Americans with Disabilities Act.