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

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