REVENUE CYCLIST SPECIALIST- ORMOND BEACH
Type: Permanent, Full-Time
Category: Medical and Nursing
Pay: $13.65 - $17.07 / Hour
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The Revenue Cycle Specialist will be responsible for follow up on Third Party Claim Reimbursements for the identification, billing and collection of payments. Under the direction of the Manager will be responsible for handling all functions relative to these areas. Responsible for providing support and service to all AHS Facilities in the Florida Hospital Central Florida Division – North Region.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
• Responsible for performing and processing accurate billing procedures for all payors, electronically through SSI (a medical claims management system that assists Florida Hospital Patient Financial services (FH PFS) insurance reimbursement team with claims editing and validation). Works independently, meeting time and daily deadlines in an accurate and efficient manner, communicating any issues to leadership.
• Ensures expeditious and accurate insurance reimbursement for all Government and Managed Care payors. Updates a high volume of daily claims appropriately in SSI system. Appropriately determines, initiates, and follows through on the status of claims in SSI, such as place on hold, delete, or assigns account error to responsible, supporting department. Documents billing, follow-up and/or collections step(s) that are taken as well as the result and next step needed to resolve the assigned payment
• Monitors and audits status of errors assigned to other areas or PFS teams for all payors daily, ensuring timely follow up and expeditious billing. Communicates with key management staff and supporting department partners effectively and professionally, to ensure key metrics are being addressed timely. Assist in identifying key trends as applicable or opportunities for improvement.
• Maintains communication between external or contracted agencies, business vendors and partners, FH department (i.e. Revenue Management, Laboratory, Contract Management, Case Management, Payors, etc.…) ensuring compliance between external relationships, knowledge of contractual terms, and performance protocols. Informs leadership of any foreseeable issues with partners. Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved.
• Processes and records agency audit notifications and responds in designated timeframe to ensure compliance with government and/or contractual requirements for timely response.
• Works all assigned insurance payers to ensure proper reimbursement on patient accounts to expedite resolution. Processes medical, administrative, technical appeals, request refunds when applicable, and rejections of insurance claims. Ensures proper escalation is met when account receivable is not collected in a timely manner.
KNOWLEDGE AND SKILLS REQUIRED:
• Computer/data entry skills required. Proficiency in performance of basic math functions. Communicates professionally and effectively, both verbally and in writing
EDUCATION AND EXPERIENCE REQUIRED:
• High School diploma or GED required.
• One-year experience in healthcare, finance, accounting, banking, insurance, or related fields.
• One year of college can be substituted for experience.
EDUCATION AND EXPERIENCE PREFERRED:
• One-year experience in healthcare claims processing or collections.