University of Florida Health
Revenue Cycle Insurance Spec
University of Florida Health, Jacksonville, Florida, United States, 32290
Overview
Under the direction of the Revenue Cycle Administrator, develop and deliver employee‑training programs. Performs work under general supervision. Handles moderately complex issues and problems, and refers more complex issues to higher‑level staff. Possesses solid working knowledge of subject matter. May provide leadership, coaching, and/or mentoring to a subordinate group.
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 while maintaining timely claims submissions and appeals processes as defined by individual payors.
Resubmit insurance claims to the appropriate carrier based on each payor’s specific process and timelines.
Research, respond to, 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 issue resolution.
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 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 as needed.
Inform Team Leader of work status, unresolved issues, backlogs, and any issues requiring immediate attention.
Identify trended denials and report to supervisor; export trended/unpaid invoices to track and provide to supervisor.
Demonstrate knowledge of specialized billing such as contracts and grants.
Perform special projects assigned by the Team Leader or Manager.
Verify completeness of registration information, update as needed, and assign insurance plan and code appropriately; enter patient demographic information using the automated billing system and verify insurance coverage via online tools.
Work overtime as needed based on business requirements.
Complete correspondence inquiries from payors, patients, and/or clinics to provide needed information for claims resolution, including medical record requests, determining other insurance coverage, authorization requirements, questionnaires, documentation research, and communication with clinics.
Respond and send emails to management across various departments to resolve coding and billing issues, maintaining timely communication to ensure action is 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 and written/electronic communications, navigating multiple web portals and websites to insurance companies for status and resolution of outstanding claims, appeals, reconsiderations, and denials.
Make outbound calls to patients to obtain correct insurance information and demographics.
Review and interpret electronic remits and EOBs to work insurance denials and determine appropriate action.
Interpret front‑end rejections, determine appropriate insurance adjustments, and obtain approvals as outlined in company policy.
Verify key data elements for charge entry such as location codes, provider numbers, authorization numbers, referring physician, CPT, ICD‑10, etc.
Qualifications Experience Requirements: 5 years of health care experience in medical billing or related field—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 the most current versions—required.
Education: High School Diploma or GED equivalent—required; Bachelor’s in Healthcare, Finance, IT, or Education—preferred.
Certification/Licensure: Certified Professional Coder (CPC)—required. CPC certification must be 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
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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 while maintaining timely claims submissions and appeals processes as defined by individual payors.
Resubmit insurance claims to the appropriate carrier based on each payor’s specific process and timelines.
Research, respond to, 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 issue resolution.
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 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 as needed.
Inform Team Leader of work status, unresolved issues, backlogs, and any issues requiring immediate attention.
Identify trended denials and report to supervisor; export trended/unpaid invoices to track and provide to supervisor.
Demonstrate knowledge of specialized billing such as contracts and grants.
Perform special projects assigned by the Team Leader or Manager.
Verify completeness of registration information, update as needed, and assign insurance plan and code appropriately; enter patient demographic information using the automated billing system and verify insurance coverage via online tools.
Work overtime as needed based on business requirements.
Complete correspondence inquiries from payors, patients, and/or clinics to provide needed information for claims resolution, including medical record requests, determining other insurance coverage, authorization requirements, questionnaires, documentation research, and communication with clinics.
Respond and send emails to management across various departments to resolve coding and billing issues, maintaining timely communication to ensure action is 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 and written/electronic communications, navigating multiple web portals and websites to insurance companies for status and resolution of outstanding claims, appeals, reconsiderations, and denials.
Make outbound calls to patients to obtain correct insurance information and demographics.
Review and interpret electronic remits and EOBs to work insurance denials and determine appropriate action.
Interpret front‑end rejections, determine appropriate insurance adjustments, and obtain approvals as outlined in company policy.
Verify key data elements for charge entry such as location codes, provider numbers, authorization numbers, referring physician, CPT, ICD‑10, etc.
Qualifications Experience Requirements: 5 years of health care experience in medical billing or related field—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 the most current versions—required.
Education: High School Diploma or GED equivalent—required; Bachelor’s in Healthcare, Finance, IT, or Education—preferred.
Certification/Licensure: Certified Professional Coder (CPC)—required. CPC certification must be 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
#J-18808-Ljbffr