Sr. Contract Reimbursement Representative (H)

University of Miami•Medley, FL

4d•Onsite

About The Position

The University of Miami/UHealth Central Business Office is hiring a full-time Contract Reimbursement Representative in Miami, Florida. The position is responsible for ensuring accurate reimbursement practices and identifying and reporting issues. The role reviews and analyzes credits, contract rates, explanations of benefits, refund requests, appeals, patient coverage, eligibility, and pre-authorizations. It also processes refunds and serves as a liaison between the Credit Balance Unit and external departments, vendors, patients, and third-party companies. The representative provides ongoing in-service training for onboarding staff and vendors. Duties may be expanded as necessary.

Requirements

High school graduate.
One year of medical billing and collections experience.
Excellent verbal and written communication skills in English.
Strong organizational skills and ability to multitask and handle difficult situations.
Knowledge and understanding of state and federal hospital regulations and medical terminology.
Excellent critical thinking, analytical, problem-solving, interpersonal, communication, and customer service skills.
Ability to work under minimal supervision, function in a high-stress environment, multitask, and establish priorities.
Knowledge of Medicare, Medicaid, managed care, third-party payer systems, and Florida Prompt Pay Law.
Ability to maintain a professional demeanor when communicating with staff, patients, and outside contacts.
Ability to maintain confidentiality of patient information.
An appropriate combination of relevant education, experience, and/or certifications may be considered.

Nice To Haves

EPIC experience preferred.

Responsibilities

Review and analyze credits within assigned work queues for proper resolution, involving payers, patients, and other entities.
Review and interpret contract rates and explanations of benefits to ensure proper reimbursement.
Serve as a liaison between the Credit Balance Unit and external departments, vendors, patients, and third-party companies on reimbursement-related inquiries.
Review payer and patient refund requests to determine validity.
Submit appeal letters within the allotted time.
Apply Florida statutes to commercial payers.
Assess patient coverage, eligibility, and pre-authorizations.
Process refunds via check, credit card portal, and wire transfer.
Provide ongoing in-service training for onboarding staff and vendors.
Identify and report reimbursement-related issues.