Strategic Revenue Cycle Insurance Specialist

UF Health; Manhattan Beach (FL); A distancia; USD 45.000 - 65.000; Jornada completa

Descripción de la vacante

UF Health is seeking an experienced Medical Billing Specialist to manage reimbursements for professional services across multiple care settings. The role requires timely submission of claims and escalation of issues to payors as needed.

The ideal candidate will have 5 years of healthcare billing experience, CPT/ICD coding knowledge, and CPC certification (to be completed within 18 months). A high school diploma is required, with a bachelor’s in healthcare, finance, IT, or education preferred.

Formación

• 5 years health care experience in Medical Billing or related field.
• Experience with CPT/ICD coding and medical terminology is preferred.
• CPC certification required; certification must be obtained within 18 months of employment.
• High School Diploma or GED; Bachelor’s healthcare/finance/IT or education preferred.

Responsabilidades

• Triage invoices and obtain reimbursement for professional services by physicians and nonphysician providers with timely claims submissions and appeals as defined by payors.
• Resubmit insurance claims according to each payor’s process and timelines.
• Research and resolve inquiries from PSRs, Cash, Charge Review, Refund, Managed Care, and other departments; follow up via emails for timely resolution.
• Communicate with payors to discuss procedure/diagnosis relationships, billing rules, and payment variances; set expectations for review or changes.
• Review and correct denials, charge posting, and payment posting errors per the UFJPI Payor Claims Matrix and Managed Care Matrix.
• Enter affected invoices into MES or other spreadsheets; flag backlogs and inform Team Leader.
• Handle enrollment and registration verification, insurance plan codes, and demographic data in the automated billing system.

Conocimientos

Medical Billing

Communication

Educación

Certified Professional Coder (CPC)

Descripción del empleo

Overview

Responsible for obtaining appropriate reimbursement for Accounts Receivables for professional services of patients seen
in physician offices, out-patient hospital, in-patient hospital, ASC, urgent care, ER, off-site hospitals and Telehealth
locations while maintaining timely claims submissions. Registers patients and completes necessary documentation
including insurance verification and benefits determination. Research charges to submit to appropriate carrier according to
Federal/Managed Care rules, regulations and compliance guidelines. Review codes using CPT, ICD10, HCPCS and CCI
guidelines to ensure compliance with institutional compliance policies for coding and claim submission. Enter and bill
professional charges into automated billing system program. Utilize resources and tools in the resolution of invoices
following company policy for assigned payor/s. Resolving outstanding balances with internal and external communication
with customers.

Responsibilities

Triage invoices and determine appropriate action and
complete the process required to obtain reimbursement for all
types of professional services by physicians and nonphysician
providers maintaining timely claims submissions
and timely Appeals processes as defined by individual
payors.

Resubmit insurance claims when necessary to the
appropriate carrier based on each payor's specific process
with the knowledge of timelines.

Research, respond and take necessary action to resolve
inquiries from PSRs (Patient Service Reps), Cash
Department, Charge Review and Refund Department
requests. Follow-up via professional emails to ensure timely
resolution of issues

Must be comfortable and knowledgeable speaking with
payors regarding procedure and diagnosis relationships,
billing rules, payment variances and have the ability to
assertively and professionally set the expectation for review
or change.

Review, research and facilitate the correction of insurance
denials, charge posting and payment posting errors.
Follow all Managed Care guidelines using the UFJPI Payor
Claims Matrix and Managed Care Matrix for each contracted
plan

Identify and enter affected invoices on the MES (Monthly
Escalation Spreadsheet) using Excel, ESM or separate
spreadsheets that may be needed

Inform Team Leader on the status of work and unresolved
issues. Alert Team Leader of backlogs or issues requiring
immediate attention

Must be knowledgeable of specialized billing, i.e. contracts
and grants

Perform special projects assigned by the Team Leader or
Manager

Verify completeness of registration information. Add and/or
update as needed. Verify and/or assign insurance plan and
code appropriately. Verify and enter patient demographic
information utilizing automated billing system. Verify
insurance coverage utilizing various online software tools.

Ability to work overtime as needed based on the needs of the
business

Complete correspondence inquiries from payors, patients
and/or clinics to provide the needed information for claims
resolution. This can include medical record requests,
determining if other health insurance coverage exists, auth
requirements, questionnaires, research of the documentation
and accounts, communicate with the clinics for additional
information needed, collaborate with providers and other
departments to obtain necessary information.

Respond and send emails to all levels of management in the
Revenue Cycle Departments, Cash Posting Department,
Refunds Department, Managed Care, Referral Department,
Clinics and the CDQ Department to resolve coding and billing
issues. Maintain timely communication to ensure all
necessary action has been taken.

Documents notes in the automated billing system regarding
patient inquiries, conversations with insurance companies,
clinics, etc. for all actions.

Receive and make outbound calls, written or electronic
communications, navigate multiple web portals and websites
to insurance companies for status and resolution of
outstanding claims. Status appeals, reconsiderations and
denials.

Make outbound calls to patients to obtain correct insurance
information and demographics
Review and interpret electronic remits and EOB's to work
insurance denials to determine appropriate action needed.
Interpret front end rejections. Determine appropriate
insurance adjustments and obtain adjustment approvals as
outlined in the company policy.

Verify and/or assign key data elements for charge entry such
as, location codes, provider #'s, authorization #'s, referring
physician, CPT, ICD-10, etc.

Qualifications

Experence Requirements: 5 years Health care experience in Medical Billing or related experience - required Proven ability to develop course work presentations. required Ability to apply adult learning methodology in training classes/presentations - required Experience with medical systems - preferred. Knowledge of CPT and ICD Coding and Medical terminology of most current versions - required Education: High School Diploma or GED equivalent - required Bachelors Healthcare, Finance, IT or Education - preferred Certification/Licensure: Certified Professional Coder (CPC) required Additional Details: CPC Certification completed within 18 months of employment. Travel Required: Up to 10% Additional Duties: Additional duties as assigned may vary.

UFJPI IS AN EQUAL OPPORTUNITY EMPLOYER AND DRUG FREE WORKPLACE