Sr. Contract Reimbursement Representative (H)

University of Miami; Oregon; Hybrid; USD 42,000 - 60,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Tuition remission

Job summary

University of Miami is seeking a full-time Contract Reimbursement Representative to ensure accurate reimbursement practices for complex payer scenarios in a fast-paced health system environment.

The role involves reviewing credits, interpreting contract rates, and liaising with multiple departments to resolve inquiries while ensuring compliance with Florida laws and confidentiality of patient information.

Qualifications

• High school diploma required.
• At least 1 year 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 in a high-stress environment.
• Knowledge of state/federal hospital regulations and medical terminology.
• Ability to maintain confidentiality of patient information.

Responsibilities

• Review credits within the assigned WQs for proper resolution with payers, patients, and other entities.
• Review and interpret contract rates to ensure proper reimbursement and EOBs.
• Liaise between Credit Balance Unit and external departments, vendors, patients, and third-party payers to address inquiries.
• Review refund requests submitted by payers and patients and submit appeal letters within deadlines.
• Apply Florida statutes to commercial payers.
• Assess patients’ coverage, eligibility, and 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

Multitasking

Analytical thinking

Problem solving

Interpersonal skills

Customer service

Confidentiality

Education

High school diploma

Tools

Epic

Job description

The University of Miami/UHealth Central Business Office has an exciting opportunity for a full-time Contract Reimbursement Representative to work in Miami, FL. The Contract Reimbursement Representative is responsible for ensuring accurate reimbursement practices. In addition, this person will identify and report any issues identified.

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.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

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 timeEmployee Type: Staff