What are the responsibilities and job description for the Explanation of Benefits (EOB), Reviewer, Full Time position at Hialeah Hospital?
Job Description
Job Description
Job Objective :
Under the direction of the Vice President of Revenue Cycle or designee, the Explanation of Benefits (EOB) Reviewer ensures all that all Commercial and Managed Care payments and adjustments are posted correctly, and that the balance is moved to the next payor or underpayment bucket accurately and timely.
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.
Knowledge
Abilities
Education
High School graduate or equivalent
Experience
Location
This position sits in our satellite office located in Westchester / Miami, FL
What Should I Know About Hialeah Hospital?
Our 378-bed acute care hospital opened in 1951 to serve the Hialeah, Florida community. Our team is committed to honoring the trust that our patients place in us by providing compassionate, safe, high-quality care in the right place, and at the right time.
Hialeah Hospital has been honored to receive a number of awards and designations for our superior health care services, including :
Cardiac
American Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018
American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018
Bariatric
American College of Surgeons / American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited Center
BCBS - Blue Distinction Specialty Care Bariatric Surgery, January 2018
Neurology
Advanced Primary Stroke Center Re-accreditation, April 2018
Women's Services
American College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016
Hyperbaric Unit
Healogics Center of Distinction Award, 2017
Laboratory Services / Blood Bank
Certificate of Accreditation from College of American Pathologist
