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

Revenue Cycle Insurance Specialist | Revenue Cycle Team 8 - Neuro/NS/Psych | Days

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 and complete the process required to obtain reimbursement for all types of professional services by physicians and nonphysician providers while 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.
• Speak with payors regarding procedure and diagnosis relationships, billing rules, payment variances and assertively 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 separate spreadsheets that may be needed.
• Inform Team Leader of the status of work and unresolved issues, and alert them of backlogs or issues requiring immediate attention.
• Maintain knowledge of specialized billing, 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.
• 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, including medical record requests, determination of other health insurance coverage, authorization requirements, questionnaires, and research of documentation and accounts.
• Communicate with clinics for additional information needed and 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.
• 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 demographics.
• Review and interpret electronic remits and EOBs 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 numbers, authorization numbers, referring physician, CPT, ICD‑10, etc.

• Experience:
  
  5 years of healthcare experience in medical billing or related field – required.
• Proven ability to develop course‑work presentations – required.
• Ability to apply adult learning methodology in training classes/presentations – required.
• Experience with medical systems – preferred.
• Knowledge of CPT, ICD coding and medical terminology of most current versions – required.
• Education:
  
  High School Diploma or GED equivalent – required.
• Bachelor’s in Healthcare, Finance, IT or Education – preferred.
• Certification:
  Certified Professional Coder (CPC) – required. CPC certification completed within 18 months of employment.
• Travel:
  Up to 10%.
• Additional duties:
  May vary based on assignment.

UFJPI is an Equal Opportunity Employer and Drug‑Free Workplace.

Mid‑Senior Level

Contract

Accounting/Auditing and Finance

Hospitals and Health Care