Psych | Days | Full-Time | REMOTE FL, GA, NC, NH, TN, Residents ONLY

UF Health•Jacksonville, FL

18d•Remote

About The Position

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.

Requirements

5 years Health care experience in Medical Billing or related experience - required
Proven ability to develop course work presentations. required
Ability to apply adult learning methodology in training classes/presentations - required
Knowledge of CPT and ICD Coding and Medical terminology of most current versions - required
Education: High School Diploma or GED equivalent - required
Certification/Licensure: Certified Professional Coder (CPC) required

Nice To Haves

Experience with medical systems - preferred.
Bachelors Healthcare, Finance, IT or Education - preferred
CPC Certification completed within 18 months of employment.

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 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 trended/unpaid invoices on Excel t to track and provide to supervisor
Must be knowledgeable of specialized billing, i.e. contracts and grants
Perform special projects assigned by the Team Leader or Manager
Verify completeness of registration information. Add and/or update as needed. Verify and/or assign insurance plan and code appropriately. Verify and enter patient demographic information utilizing automated billing system. Verify insurance coverage utilizing various online software tools.
Ability to work overtime as needed based on the needs of the business
Complete correspondence inquiries from payors, patients and/or clinics to provide the needed information for claims resolution. This can include medical record requests, determining if other health insurance coverage exists, auth requirements, questionnaires, research of the documentation and accounts, communicate with the clinics for additional information needed, collaborate with providers and other departments to obtain necessary information.
Respond and send emails to all levels of management in the Revenue Cycle Departments, Cash Posting Department, Refunds Department, Managed Care, Referral Department, Clinics and the CDQ Department to resolve coding and billing issues. Maintain timely communication to ensure all necessary action has been taken.
Documents notes in the automated billing system regarding patient inquiries, conversations with insurance companies, clinics, etc. for all actions.
Receive and make outbound calls, written or electronic communications, navigate multiple web portals and websites to insurance companies for status and resolution of outstanding claims. Status appeals, reconsiderations and denials.
Make outbound calls to patients to obtain correct insurance information and demographics
Review and interpret electronic remits and EOB's to work insurance denials to determine appropriate action needed. Interpret front end rejections. 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, CPT, ICD-10, etc.