University of Florida Jacksonville Physicians, Inc.
Revenue Cycle Insurance Specialist | Revenue Cycle - Team 7 Emergency Medicine |
University of Florida Jacksonville Physicians, Inc., Jacksonville, Florida, United States, 32290
Revenue Cycle Insurance Specialist | Revenue Cycle - Team 7 Emergency Medicine | Days | Full-Time | REMOTE FL, GA, NC, NH, TN, Residents ONLY
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Overview Responsible for obtaining appropriate reimbursement for Accounts Receivables for professional services of patients seen in physician offices, outpatient hospital, inpatient 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. Researches charges to submit to the appropriate carrier according to federal and managed‑care rules, regulations and compliance guidelines. Reviews codes using CPT, ICD‑10, HCPCS, and CCI guidelines to ensure compliance with institutional policies for coding and claim submission. Enters and bills professional charges into the automated billing system. Utilizes resources and tools to resolve invoices following company policy for assigned payor(s) and resolves outstanding balances with internal and external communication with customers.
Responsibilities
Triage invoices to determine appropriate action and complete the process required to obtain reimbursement for all types of professional services by physicians and non‑physician providers, maintaining timely claims submissions and appeals processes as defined by individual payors.
Resubmit insurance claims when necessary to the appropriate carrier based on each payor's specific processes and timelines.
Research, respond and take necessary action to resolve inquiries from PSRs (Patient Service Reps), Cash Department, Charge Review and Refund Department requests, and follow up via professional emails to ensure timely resolution of issues.
Communicate with payors regarding procedure and diagnosis relationships, billing rules, payment variances and assertively set expectations for review or change.
Review, research and facilitate the correction of insurance denials, charge posting and payment 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 other spreadsheets as needed.
Inform Team Leader on the status of work and unresolved issues, and alert the Team Leader of backlogs or issues requiring immediate attention.
Identify trended denials and report to supervisor, exporting trended/unpaid invoices to Excel for tracking and provision to supervision.
Perform special projects assigned by the Team Leader or Manager.
Verify completeness of registration information and update as needed; assign insurance plan and codes appropriately; enter patient demographic information and verify insurance coverage using online tools.
Work overtime as needed based on business requirements.
Complete correspondence inquiries from payors, patients, and/or clinics to provide the information needed for claims resolution, including medical record requests, determination of other health insurance coverage, authorizations, questionnaires, and documentation research.
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.
Document 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 EOBs to resolve insurance denials and determine appropriate action, interpret front‑end rejections, and obtain adjustment approvals as outlined in company policy.
Verify and assign key data elements for charge entry such as location codes, provider numbers, authorization numbers, referring physician, CPT, ICD‑10, etc.
Qualifications Experience Requirements
3 years of healthcare experience in medical billing – Preferred
EPIC system experience – Preferred
Experience with online payor tools – Preferred
Education
High School Diploma or GED equivalent – Required
Associate’s degree – Preferred
Certification / Licensure
Certificate – Medical Terminology – Preferred
Additional Duties
Additional duties as assigned may vary.
UFJPI is an Equal Opportunity Employer and a Drug-Free Workplace.
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Overview Responsible for obtaining appropriate reimbursement for Accounts Receivables for professional services of patients seen in physician offices, outpatient hospital, inpatient 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. Researches charges to submit to the appropriate carrier according to federal and managed‑care rules, regulations and compliance guidelines. Reviews codes using CPT, ICD‑10, HCPCS, and CCI guidelines to ensure compliance with institutional policies for coding and claim submission. Enters and bills professional charges into the automated billing system. Utilizes resources and tools to resolve invoices following company policy for assigned payor(s) and resolves outstanding balances with internal and external communication with customers.
Responsibilities
Triage invoices to determine appropriate action and complete the process required to obtain reimbursement for all types of professional services by physicians and non‑physician providers, maintaining timely claims submissions and appeals processes as defined by individual payors.
Resubmit insurance claims when necessary to the appropriate carrier based on each payor's specific processes and timelines.
Research, respond and take necessary action to resolve inquiries from PSRs (Patient Service Reps), Cash Department, Charge Review and Refund Department requests, and follow up via professional emails to ensure timely resolution of issues.
Communicate with payors regarding procedure and diagnosis relationships, billing rules, payment variances and assertively set expectations for review or change.
Review, research and facilitate the correction of insurance denials, charge posting and payment 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 other spreadsheets as needed.
Inform Team Leader on the status of work and unresolved issues, and alert the Team Leader of backlogs or issues requiring immediate attention.
Identify trended denials and report to supervisor, exporting trended/unpaid invoices to Excel for tracking and provision to supervision.
Perform special projects assigned by the Team Leader or Manager.
Verify completeness of registration information and update as needed; assign insurance plan and codes appropriately; enter patient demographic information and verify insurance coverage using online tools.
Work overtime as needed based on business requirements.
Complete correspondence inquiries from payors, patients, and/or clinics to provide the information needed for claims resolution, including medical record requests, determination of other health insurance coverage, authorizations, questionnaires, and documentation research.
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.
Document 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 EOBs to resolve insurance denials and determine appropriate action, interpret front‑end rejections, and obtain adjustment approvals as outlined in company policy.
Verify and assign key data elements for charge entry such as location codes, provider numbers, authorization numbers, referring physician, CPT, ICD‑10, etc.
Qualifications Experience Requirements
3 years of healthcare experience in medical billing – Preferred
EPIC system experience – Preferred
Experience with online payor tools – Preferred
Education
High School Diploma or GED equivalent – Required
Associate’s degree – Preferred
Certification / Licensure
Certificate – Medical Terminology – Preferred
Additional Duties
Additional duties as assigned may vary.
UFJPI is an Equal Opportunity Employer and a Drug-Free Workplace.
#J-18808-Ljbffr