LRHPG Reimb/Denials/Appeals Spec - LRHPG-Revenue Cycle

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Active - Benefit Eligible and Accrues Time Off

The Reimbursement/Denials/Appeals Specialist is a dedicated following up on all medical billing and claims activity initiated from within a centralized business office. The worker in this role is responsible for thoroughly managing assigned claims with accuracy and on a timely basis for achieving the appropriate reimbursement for services rendered.

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

People At The Heart Of All We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
• Safety And Performance Improvement
  • Behaves in a mindful manner focused on self, patient, visitor, and team safety.
  • Demonstrates accountability and commitment to quality work.
  • Participates actively in process improvement and adoption of standard work.
  • Stewardship
  • Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
  • Knows and adheres to organizational and department policies and procedures.
  • Standard Work Duties: AMB Reimb/Denials/Appeals Specialist
  • Follow-up insurance accounts timely and accurately to secure prompt payment to the practice
  • Maximize technology use for timely productivity on claims follow-up and status review
  • Utilize payer websites regularly to optimally perform assigned duties as assigned, and reporting any accessibility issues to supervisor immediately to regain site access
  • Follow set guidelines for the appeals process set by payers, and ensures that claims are contested on a timely manner
  • Follow guidelines set by payers to appeal any denied claims on a consistent and timely basis
  • Proactive approach to communicate errors to the appropriate staff, clinics, physicians, and management.
  • Meets daily productivity goals of 75-100 accounts per day
  
  

Essential:

• High School or Equivalent

• Associate Degree

Nonessential:

• Business or Healthcare Administration