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University of Florida Jacksonville Physicians, Inc. · 3 weeks ago

Revenue Cycle Insurance Specialist | Revenue Cycle - Team 4- Int Med | Days | Full-Time | REMOTE FL, GA, NC, NH, TN, Residents ONLY

United States

Full-time

Remote

Senior Level

5+ years exp

University of Florida Jacksonville Physicians, Inc. is seeking a Revenue Cycle Insurance Specialist. This role involves developing and delivering employee-training programs while handling moderately complex issues related to insurance claims and reimbursements.

Hospital & Health Care

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

Identify trended denials and report to supervisor, export trended/unpaid invoices on Excel to track and provide to supervisor

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

Qualification

Medical BillingCPT CodingICD-10 CodingTraining DevelopmentHealthcare ExperienceMedical TerminologyExcel ProficiencyCommunication SkillsProblem SolvingLeadership SkillsCollaboration SkillsAttention to Detail