Revenue Cycle Insurance Specialist | Revenue Cycle Admin PRN Pool | REMOTE FL, GA, NC

Revenue Cycle Insurance Specialist

Join to apply for the Revenue Cycle Insurance Specialist | Revenue Cycle Admin | Days | PRN Pool | REMOTE FL, GA, NC, NH , TN, Residents ONLY role at University of Florida Jacksonville Physicians, Inc.

Responsible for obtaining appropriate reimbursement for Accounts Receivables for professional services of patients seen in physician offices, out‑patient hospital, in‑patient hospital, ASC, urgent care, ER, off‑site hospitals and Telehealth locations while maintaining timely claims submissions. Registers patients and completes necessary documentation including insurance verification and benefits determination. Researches charges to submit to appropriate carrier according to Federal/Managed Care rules, regulations and compliance guidelines.

Reviews codes using CPT, ICD‑10, HCPCS and CCI guidelines to ensure compliance with institutional compliance policies for coding and claim submission. Enters and bills professional charges into an automated billing system program. Utilizes resources and tools in the resolution of invoices, following company policy for assigned payor/s. Resolves outstanding balances with internal and external communication with customers.

• Triage invoices and determine appropriate action to obtain reimbursement for all types of professional services by physicians and non‑physician providers, maintaining timely claims submissions and appeal processes as defined by individual payors.
• Resubmit insurance claims when necessary to the appropriate carrier based on each payor's specific process and timeline knowledge.
• 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 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 separate spreadsheets as needed.
• Inform Team Leader on work status and unresolved issues; alert them of backlogs or issues requiring immediate attention.
• Identify trended denials and report them to supervisor; export trended/unpaid invoices on Excel to track and provide to supervisor.
• Be knowledgeable of specialized billing, e.g., contracts and grants.
• Perform special projects assigned by the Team Leader or Manager.
• Verify completeness of registration information; add and/or update as needed, assign insurance plan and code appropriately.
• Verify and enter patient demographic information utilizing the automated billing system; verify insurance coverage using various online software tools.
• Availability 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 (medical record requests, determining other health insurance coverage, authorization requirements, questionnaires, document research, etc.).
• 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, appeals, reconsiderations and denials.
• Make outbound calls to…