Revenue Cycle Insurance Specialist | Revenue Cycle - Team Neuro​/NS​/Psych

Revenue Cycle Insurance Specialist | Revenue Cycle - Team 8 Neuro/NS/ Psych | Days | Full-Time | REMOTE FL, GA, NC, NH, TN, Residents ONLY

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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.

• Triage invoices and determine appropriate action; complete the process required to obtain reimbursement for all types of professional services by physicians and nonphysician providers while maintaining timely claim submissions and 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 has the ability to assertively and professionally set expectations 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 other spreadsheets as needed.
• Inform Team Leader on 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 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 using the automated billing system; verify insurance coverage using 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 needed information for claims resolution, including medical record requests, determining if other health insurance coverage exists, authorization requirements, questionnaires, research of documentation and accounts, communicating with clinics for additional information, collaborating with providers and other departments.
• 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.
• Document 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…