University of Florida Health - Jacksonville, FL
posted 16 days ago
About the position
The position is responsible for obtaining appropriate reimbursement for accounts receivables related to professional services provided to patients across various locations. This includes maintaining timely claims submissions and registering patients while completing necessary documentation such as insurance verification and benefits determination. The role involves researching charges to submit to the appropriate carrier in accordance with Federal and Managed Care rules, regulations, and compliance guidelines. Additionally, the position requires reviewing codes using CPT, ICD10, HCPCS, and CCI guidelines to ensure compliance with institutional policies for coding and claim submission. The individual will enter and bill professional charges into an automated billing system and utilize resources to resolve invoices following company policy for assigned payors. Communication with customers is essential for resolving outstanding balances.
Responsibilities
- Determine appropriate action and complete action required to obtain reimbursement for all types of professional services by physicians and non-physician providers maintaining timely claims submissions and timely Appeals process as defined by individual payors.
- Complete correspondence inquiries from payors, patients and/or clinics to provide the needed information for claims resolution.
- Respond and send emails to all levels of management in the Business Groups, Cash Posting Department, Refunds Department, Managed Care, Clinics or CDQ to resolve coding and billing issues.
- Make outbound calls, written or electronic communications, web portals and or websites to insurance companies for status and resolution of outstanding claims.
- Review and interpret electronic remits and EOB's to work insurance denials and to 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 and etc.
- Re-file insurance claims when necessary to the appropriate carrier based on each payors specific appeals process with the knowledge of timelines.
- Research, respond and take necessary action to resolve inquiries from PSRs, Charge Review and Refund Department requests. Follow-up via professional emails to ensure timely resolution of issues.
- Must be comfortable speaking with payers regarding procedure and diagnosis relationships, billing rules, payment variances and have the ability to assertively set the expectation for review or change.
- Review and facilitate the correction of insurance denials, charge posting and payment posting errors.
Requirements
- Customer Service working with Internal & External Clients.
- Strong analytical, problem solving and follow up skills.
- Excellent interpersonal and communication skills.
- Handles confidential health information in compliance with HIPAA.
- Ability to work as a team is essential to the individual's success.
- Strong telephone skills.
- Ability to operate standard business equipment, e.g., copier and fax machine.
- Working knowledge of HMOs, Medicare, Medicaid, PPO and third party payers.
- Knowledge of procedure and diagnosis coding and medical terminology.
- Strong PC skills required using Excel and Word.
Nice-to-haves
- 2 years Health care experience in medical billing preferred
- EPIC system experience preferred
- Experience with online payor tools preferred
