University of Florida Jacksonville Healthcare, Inc.
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at University of Florida Jacksonville Healthcare, Inc.
Job Status: Full Time
Job Reference #: 4167
• Determine appropriate action and complete action required to obtain reimbursement for all types of professional services by physicians and non-physician providers maintaining timely claims submissions and timely Appeals process as defined by individual payors.
Complete correspondence inquiries from payors
• Complete correspondence inquiries from payors, patients and/or clinics to provide the needed information for claims resolution.
Respond and send emails to all levels of management
• Respond and send emails to all levels of management in the Business Groups, Cash Posting Department, Refunds Department, Managed Care, Clinics or CDQ to resolve coding and billing issues. Send follow up emails to ensure all necessary action is taken.
Make outbound calls, written or electronic communications
• Make outbound calls, written or electronic communications, web portals and or websites to insurance companies for status and resolution of outstanding claims.
Review and interpret electronic remits and EOB’s
• Review and interpret electronic remits and EOB’s to work insurance denials and to determine appropriate insurance adjustments and obtain adjustment approvals as outlined in the company policy.
• Verify and/or assign key data elements for charge entry
• Verify and/or assign key data elements for charge entry such as, location codes, provider #’s, authorization #’s, referring physician and etc.
Re-file insurance claims when necessary
• Re-file insurance claims when necessary to the appropriate carrier based on each payors specific appeals process with the knowledge of timelines.
Research, respond and take necessary action
• Research, respond and take necessary action to resolve inquiries from PSRs, Charge Review and Refund Department requests. Follow-up via professional emails to ensure timely resolution of issues.
Must be comfortable speaking with payers
• Must be comfortable speaking with payers regarding procedure and diagnosis relationships, billing rules, payment variances and have the ability to assertively set the expectation for review or change.
Review and facilitate the correction of insurance
• Review and facilitate the correction of insurance denials, charge posting and payment posting errors.
Adhere to company policies and procedures, demonstrate the core values and Hospitality behaviors, resolve conflict through open, honest, professional communication, demonstrate positive and enthusiastic attitude, keep supervisor and leadership apprised of issues, and seek opportunities to recognize others.
• Customer Service working with Internal & External Clients.
• Strong analytical, problem solving and follow up skills.
• Excellent interpersonal and communication skills.
• Handles confidential health information in compliance with HIPAA.
• Ability to work as a team is essential to the individual's success.
• Strong telephone skills.
• Ability to operate standard business equipment, e.g., copier and fax machine.
• Working knowledge of HMOs, Medicare, Medicaid, PPO and third party payers.
• Knowledge of CPT-4 and ICD-10 coding and medical terminology.
• Strong PC skills required using Excel and Word.
Length of Experience
Type of Experience
Health care experience in medical billing
Computer experience in medical billing
EPIC system experience
Experience with online payor tools
Education & Certifications
Program of Study
High School Diploma or GED equivalent
Certified Professional Coder (CPC)
UFJPI is an equal opportunity employer