Revenue Cycle Insurance Spec

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. Job Requirement 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 Qualifications Experience Requirements 3 years Health care experience in medical billing preferred EPIC system experience preferred Experience with online payor tools preferred Education High School Diploma or GED equivalent - required Associates degree - preferred Certification/Licensure Certificate - Medical Terminology - preferred Additional Duties Additional duties as assigned may vary. UFJPI IS AN EQUAL OPPORTUNITY EMPLOYER AND DRUG FREE WORKPLACE Experience Requirements 3 years Health care experience in medical billing preferred EPIC system experience preferred Experience with online payor tools preferred Education High School Diploma or GED equivalent - required Associates degree - preferred Certification/Licensure Certificate - Medical Terminology - preferred Additional Duties Additional duties as assigned may vary. UFJPI IS AN EQUAL OPPORTUNITY EMPLOYER AND DRUG FREE WORKPLACE