What are the responsibilities and job description for the Explanation of Benefits (EOB), Reviewer, Full Time position at Hialeah Hospital?
Duties and Responsibilities:
- Verify that all payments and adjustments are posted to correct insurance plan.
- Verify that payments are paid per the terms of the contract and adjust balances, as needed.
- Assign and forward all under-paid accounts to the Appeals Department
- Move balances and/or queue secondary claims, as needed.
- Move remaining balance to self-pay, as appropriate.
- Assist with posting zero payment EOBs, as needed.
- Ensure if Insurance over paid that it is assigned to the pending Insurance refund agency.
- Pull supporting documents for annual regulatory audits, as needed.
- Other duties as assigned, within skillsets and abilities.
- Working knowledge of HMO, PPO, and Commercial reimbursement
- Working knowledge of Managed Care contract language and interpretation
- Technical knowledge of all reimbursement methodologies, APC, DRG, Per Diem, etc.
- Strong analytical and math skills.
- Ability to work in a fast-paced team environment, as well as independently.
- Ability to remain professional and courteous at all times, regardless of the situation.
- Minimum 1-year previous Commercial, HMO and PPO insurance follow-up experience
- Previous EOB Reviewer experience, preferred.
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