ACCOUNTANT I - 64043439

State of Florida • Miami, FL

1d • $45,000 - $48,000 • Onsite

About The Position

This is a highly responsible and independent accounting position working with the billing office and under the direct supervision of Revenue Administrator I - SES. This position is responsible for all activities related to processed payment posting in HMS also collections process including adjustments and resubmissions of claims denied for payment. These responsibilities include the accurate and timely processing of all claims corrections and re-submissions and claims appealing process for the Florida Department of Health in Miami Dade. Ensuring all claims are submitted in accordance with each vendor’s established policy and procedures. Must possess full knowledge of all medical benefit levels, fee schedule and cost-based reimbursement methodology and regulatory requirements for medical reimbursement. Maintains and respects the confidentiality of patient information in accordance with the County Health Department guidelines, the Miami-Dade County Health department policies & procedures, and HIPAA guidelines.

Ensures all payments and adjustments to the specified patient accounts are posted in accordance with established policies and procedures. Ensure that all payments received are posted, deposited, and reconciled accurately and efficiently. Monitors the workflows and priorities of the payment posting process including but not limited to: payment posting, electronic funds transfers and check deposits. Collaborate with the Accounts Receivable Team to guarantee that all payments are being reconciled. Communicate with insurance companies and their partners as necessary to ensure payments and remittances are properly received and posted. Identifies key opportunities to improve outdated processes and systems. Serves as the domain expert in the payment posting department. Mentors and develop team members to ensure cross functional skill sets. Creates and updates the daily posting payment reports in Excel.

Verifies Medicaid, Medicare and private insurance coverage to submit claims to the corresponding entity. Using FMMIS or other Medicaid or Medicare verification system to identify eligible clients. Reviews claim data submitted on encounter forms for completeness and compliance with guidelines. Prepare encounter forms for all health units to request third party reimbursement for services rendered to patients. Post payments within 48 hours of receipt date. Re-processes denials within one week of receipt date. This involves working on sensitive confidential information pertaining to clients. Must use the HMS system to process all third parties billing.

Tracks past due accounts by classifying them into 30, 60, 90, and 120 + days past due, and follows up on the account balances and obtains payments as necessary. Enter payments and adjustments into patient's accounts; reconciles patients' accounts according to status of Paid, Denied, or Pending. Presents account for write-off according to departmental guidelines and generate weekly and monthly end reports. Reviews of State Lab invoices in a monthly basis, to verify services charged, were surely provided and recorded in HMS.

Maintain claims pending file in alphabetized order with supporting documentation. Maintain alphabetized clients file with demographic information. Maintain private insurance files with company information. Maintain physician file by date of service with billing information. Maintain health unit file by date with billing contact information. Maintain billing annually with updates information.

Attend meetings and training as requested, regarding the program, and in-service education to enhance professional growth. Ensures accurate completion and timely submission of all administrative records including EARS, timesheets, mileage, FDENs, etc. Receives and services telephone calls to verify information on clients, eligibility periods, account status and other information.

Performs all other duties as assigned.

Requirements

• Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms, and other office procedures and terminology according to the program needs.
• Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Ability to effectively manage one's own time.
• Ability to speak clearly so others can understand you.
• Ability to communicate information and ideas in speaking so others will understand.
• Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
• Ability to use Web Portal and Interchange Medicaid verification system.
• Knowledge of HMS- billing module.
• Medical billing experience.

Nice To Haves

• Full knowledge of all medical benefit levels, fee schedule and cost-based reimbursement methodology and regulatory requirements for medical reimbursement.

Responsibilities

• Responsible for all activities related to processed payment posting in HMS and collections process including adjustments and resubmissions of claims denied for payment.
• Accurate and timely processing of all claims corrections and re-submissions and claims appealing process.
• Ensuring all claims are submitted in accordance with each vendor’s established policy and procedures.
• Maintaining and respecting the confidentiality of patient information in accordance with County Health Department guidelines, Miami-Dade County Health department policies & procedures, and HIPAA guidelines.
• Ensuring all payments and adjustments to patient accounts are posted in accordance with established policies and procedures.
• Ensuring all payments received are posted, deposited, and reconciled accurately and efficiently.
• Monitoring the workflows and priorities of the payment posting process including payment posting, electronic funds transfers and check deposits.
• Collaborating with the Accounts Receivable Team to guarantee that all payments are being reconciled.
• Communicating with insurance companies and their partners as necessary to ensure payments and remittances are properly received and posted.
• Identifying key opportunities to improve outdated processes and systems.
• Serving as the domain expert in the payment posting department.
• Mentoring and developing team members to ensure cross functional skill sets.
• Creating and updating the daily posting payment reports in Excel.
• Verifying Medicaid, Medicare and private insurance coverage to submit claims to the corresponding entity.
• Using FMMIS or other Medicaid or Medicare verification system to identify eligible clients.
• Reviewing claim data submitted on encounter forms for completeness and compliance with guidelines.
• Preparing encounter forms for all health units to request third party reimbursement for services rendered to patients.
• Posting payments within 48 hours of receipt date.
• Re-processing denials within one week of receipt date.
• Tracking past due accounts by classifying them into 30, 60, 90, and 120 + days past due, and following up on account balances and obtaining payments as necessary.
• Entering payments and adjustments into patient's accounts; reconciling patients' accounts according to status of Paid, Denied, or Pending.
• Presenting accounts for write-off according to departmental guidelines and generating weekly and monthly end reports.
• Reviewing State Lab invoices on a monthly basis to verify services charged were provided and recorded in HMS.
• Maintaining claims pending file in alphabetized order with supporting documentation.
• Maintaining alphabetized clients file with demographic information.
• Maintaining private insurance files with company information.
• Maintaining physician file by date of service with billing information.
• Maintaining health unit file by date with billing contact information.
• Maintaining billing annually with updated information.
• Attending meetings and training as requested, regarding the program, and in-service education to enhance professional growth.
• Ensuring accurate completion and timely submission of all administrative records including EARS, timesheets, mileage, FDENs, etc.
• Receiving and servicing telephone calls to verify information on clients, eligibility periods, account status and other information.
• Performing all other duties as assigned.

Benefits

• Annual and Sick Leave benefits
• Nine paid holidays and one Personal Holiday each year
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
• Retirement plan options, including employer contributions
• Flexible Spending Accounts
• Tuition waivers

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed