Revenue Cycle Insurance Spec | Patient Billing Coordinator | Days | Full-Time

OverviewResponsible 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.Research charges to submit to appropriate carrier according to Federal/Managed Care rules, regulations and compliance guidelines.Review codes using CPT, ICD10, HCPCS and CCI guidelines to ensure compliance with institutional compliance policies for coding and claim submission.Enter and bill professional charges into automated billing system program.Utilize resources and tools in the resolution of invoices following company policy for assigned payor/s.Resolving outstanding balances with internal and external communication with customers.Job RequirementTriage 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 issuesMust 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 planIdentify and enter affected invoices on the MES (Monthly Escalation Spreadsheet) using Excel, ESM or separate spreadsheets that may be neededInform Team Leader on the status of work and unresolved issues. Alert Team Leader of backlogs or issues requiring immediate attentionIdentify trended denials and report to supervisor, exportQualificationsExperience RequirementsEPIC System Experience Preferred3 years Health care experience in medical billing preferredExperience With Online Payor Tools PreferredEducationHigh School Diploma or GED equivalent - requiredAssociates degree - preferredCertification/Licensure Certificate - Medical Terminology - preferredAdditional DutiesAdditional duties as assigned may vary.UFJPI IS AN EQUAL OPPORTUNITY EMPLOYER AND DRUG FREE WORKPLACE