Insurance Receivable Specialist III

University of Utah Health; Salt Lake City (UT); Vor Ort; USD 42.000 - 60.000; Vollzeit

Zusammenfassung

University of Utah Health is seeking a qualified Billing Specialist to manage bundled billing processes, including episode creation and bundled packet preparation, and to ensure contract compliance and timely reimbursements.

The role involves reconciliation of HB/PB claims and payments, escalation of issues to appropriate departments, and resolving denials through CARC analysis. A patient advocate approach is essential to balance resolution and accurate patient billing.

Qualifikationen

• Four years of medical billing experience.

Aufgaben

• Performs insurance follow-up, denial resolution, and contract compliance ensuring timely and appropriate reimbursement, based on contract terms.
• Performs bundled billing functions including oversight of registration, charge routing, episode creation and preparing bundled packet.
• Performs reconciliation functions including HB/PB claims, Hospital / Physician payments, disbursements and episode balancing.
• Escalates claim's issues internally to other key departments (including Coding, Billing, Charging, Contracting, etc.).
• Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review, coordination with UR and/or attending physician.
• Acts as patient advocate in the resolution of balances.
• Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned.

Kenntnisse

Clear communication

Analytical thinking

Ownership

Detail oriented

Customer service

Problem solving

Jobbeschreibung

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for bundled billing processes including episodic billing, contract compliance, reconciliation, and customer service. This position is not responsible for providing patient care.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Performs insurance follow-up, denial resolution, and contract compliance ensuring timely and appropriate reimbursement, based on contract terms.
• Performs bundled billing functions including oversight of registration, charge routing, episode creation and preparing bundled packet.
• Performs reconciliation functions including HB/PB claims, Hospital / Physician payments, disbursements and episode balancing.
• Escalates claim's issues internally to other key departments (including Coding, Billing, Charging, Contracting, etc.).
• Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review, coordination with UR and/or attending physician.
• Acts as patient advocate in the resolution of balances.
• Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned.

Knowledge / Skills / Abilities

• The ability to express information in a clear and understandable manner.
• Ability to take a logical approach to resolutions.
• Ability to take ownership for the quality and timeliness of work and can achieve results with little oversight.
• Ability to resolve difficult or complicated challenges.
• Attends to details and pursues quality in accomplishing tasks.
• The ability to service and resolve customer requests with the customer in mind first and foremost.
• Demonstrated skills in analytical thinking.

Required Qualifications

• Four years of medical billing experience.

Preferred Qualifications (Preferred)

• Medical Billing terminology.
• Claims knowledge through AAHAM.
• Accounting reconciliation skills.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Color Determination, Listening, Manual Dexterity, Near Vision, Sitting, Speaking, Standing