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

About the Role

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. This includes registering patients, completing necessary documentation such as insurance verification and benefits determination, and ensuring compliance with Federal/Managed Care rules, regulations, and guidelines.

Responsibilities

• 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 Appeals processes as defined by individual payors.
• Resubmit insurance claims when necessary to the appropriate carrier based on each payor's specific process and timelines.
• Research, respond, and resolve inquiries from Patient Service Reps (PSRs), Cash Department, Charge Review, and Refund Department requests.
• Follow up via professional emails to ensure timely resolution of issues.
• Communicate 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 Monthly Escalation Spreadsheet (MES) using Excel, ESM, or separate spreadsheets.
• Inform Team Leader on the status of work and unresolved issues, and alert them of backlogs or issues requiring immediate attention.
• Identify trended denials and report to supervisor; export data as needed.
• Perform specialized billing tasks, such as contracts and grants.
• Complete special projects assigned by the Team Leader or Manager.
• Verify completeness of registration information, updating or adding details as needed.
• Verify and/or assign insurance plans and codes appropriately.
• Verify and enter patient demographic information utilizing the automated billing system.
• Verify insurance coverage using various online software tools.
• Work overtime as needed based on business requirements.
• Complete correspondence inquiries from payors, patients, and/or clinics to resolve claims, including medical record requests, insurance coverage verification, authorization requirements, and collaboration with providers or other departments.
• Respond to and send emails to all levels of management in Revenue Cycle Departments, Cash Posting, Refunds, Managed Care, Referral Department, Clinics, and CDQ Department to resolve coding and billing issues.
• Maintain timely communication to ensure all necessary actions are taken.
• Document notes in the automated billing system regarding patient inquiries, conversations with insurance companies, clinics, etc.
• Receive and make outbound calls, written or electronic communications, and navigate multiple insurance web portals for claim status and resolution.
• Handle 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 and determine appropriate action.
• Interpret front-end rejections and determine appropriate insurance adjustments, obtaining approvals as outlined in 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.

Requirements

• 5 years of healthcare experience in Medical Billing or related experience (required).
• Proven ability to develop coursework presentations (required).
• Ability to apply adult learning methodology in training classes/presentations (required).
• Experience with medical systems (preferred).
• Knowledge of CPT and ICD coding and medical terminology of the most current versions (required).

Qualifications

• High School Diploma or GED equivalent (required).
• Bachelor’s degree in Healthcare, Finance, IT, or Education (preferred).
• Certified Professional Coder (CPC) certification (required; must be completed within 18 months of employment).

Additional Details

• Travel required: Up to 10%.
• Additional duties as assigned may vary.