Sr. Contract Reimbursement Representative (H)

200 UM Corp (Enterprise); Avenue (MD); On-site; USD 45,000 - 60,000; Full time

Job summary

The University of Miami Health System is seeking a Medical Billing Clerk to review credits and interpret contract rates for proper reimbursement. You will liaise with payers, patients and third-party vendors to address inquiries and ensure refund validity.

The role requires knowledge of medical terminology, state and federal hospital regulations, and strong communication, organization, and confidentiality. Training and education support are provided.

Qualifications

• High school diploma required.
• 1 year medical billing and collections experience.
• EPIC experience preferred.
• Excellent English communication (verbal and written).
• Strong organizational skills and ability to multi-task.
• Knowledge of state/federal hospital regulations and medical terminology.
• Ability to maintain confidentiality of patient information.
• Professional demeanor with staff, patients and external contacts.

Responsibilities

• Review and analyze credits within the assigned WQs for proper resolution, involving payers, patients, and other entities.
• Review and interpret contract rates to ensure proper reimbursement, as well as EOBs.
• Serve as a liaison between the Credit Balance Unit and external departments, vendors, patients, and Third Party Companies to address reimbursement-related inquiries.
• Review refund requests submitted by payers and patients to ensure validity.
• Submit appeal letters within the allotted time.
• Apply Florida Statutes accordingly to commercial payers.
• Assess patients' coverage and eligibility, as well as pre-authorizations.
• Process refunds via check, credit card portal, and wire transfer.
• Provide ongoing in-service training for onboarding staff and vendors.

Skills

Verbal communication

Written communication

Organizational skills

Multi-tasking

Customer service

Analytical thinking

Problem solving

Confidentiality

Education

High school diploma

Tools

EPIC

Job description

CORE JOB FUNCTIONS

Review and analyze credits within the assigned WQs for proper resolution, involving payers, patients, and other entities.

Review and interpret contract rates to ensure proper reimbursement, as well as EOBs.

Serve as a liaison between the Credit Balance Unit and external departments, vendors, patients, and Third Party Companies to address reimbursement-related inquiries.

Review refund requests submitted by payers and patients to ensure validity.

Submit appeal letters within the allotted time.

Apply Florida Statutes accordingly to commercial payers.

Assess patients' coverage and eligibility, as well as pre-authorizations.

Process refunds via check, credit card portal, and wire transfer.

Provide ongoing in-service training for onboarding staff and vendors.

CORE QUALIFICATIONS

High school graduate.

One year (1) of medical billing and collections experience.

EPIC experience preferred.

Excellent verbal and written communication skills in English.

Strong organizational skills and ability to multi-task and deal with difficult situations.

Must have knowledge and understanding of state/federal hospital regulations and medical terminology.

Must have excellent critical thinking, analytical, problem-solving, interpersonal, communication, and customer service skills.

Work under minimal supervision, function in a high-stress environment, and multi-task while establishing priorities.

Knowledge of Medicare, Medicaid, Managed Care, Third Party Payer System, and Florida Prompt Pay Law.

Ability to maintain a professional demeanor when communicating with staff, patients, and all outside contacts.

Must be able to maintain confidentiality of patient information.

Any appropriate combination of relevant education, experience and/or certifications may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine.

As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean.

Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year.

Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care.

We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer.

Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status: Full time Employee Type: Staff

The mission of the University of Miami is to transform lives through education, research, innovation, and service.

A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation.

The University comprises 12 schools and colleges serving undergraduate and graduate students in more than 350 majors and programs.

Visit welcome.miami.edu/about-um to learn more about our points of pride.

The University ranks No. 55 on U.S. News & World Report’s 2022 Best Colleges list and ranked No. 49 in the 2022 Wall Street Journal/Times Higher Education College Rankings.

Bascom Palmer Eye Institute is ranked the #1 eye hospital in the USA and offers some of the nation's premiere eye doctors to treat every eye condition for adults.

Sylvester Comprehensive Cancer, part of the Miller School of Medicine, received the prestigious National Cancer Institute designation in 2019.

The University of Miami and UHealth have also ranked among the Forbes Best Employers and Best Employers for Women on several occasions, most recently in 2022.

With more than 17,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe.

The University of Miami is an Equal Opportunity Employer.

Applicants and employees are protected from discrimination based on certain categories protected by Federal law.