Job Family: Professional-NonClinical
Full/Part Time: Full Time
Shift/Days: Day
FTE: 1.00
Department: Special Projects Group
Organization: Jacksonville Physicians, Inc.
Overview
JOB DUTIES
Combines strong analytical skills with knowledge of managed care and billing concepts to identify variances in payment compared to expected reimbursement from contracted Managed Care and Governmental Payers. Analyst is responsible for assisting Lead and Manager of Special Projects in problem solving, reconciling and collection of payment variances for issues related to contract compliance and contracted payer performance using online tools, Excel, written and verbal communication. Analyst serves as the liaison between Business Groups, UF Health Managed Care and Payers for the purpose of resolving individual and trended issues. Includes contract content review, application of appropriate contract terms, fee schedules, identification and reporting of trends to Manager. Responsible for Research Department claims and training of research coordinators on Epic billing process.
Essential Functions
• Analyze invoices in Epic follow-up work queues to determine contracted insurance payment compliance by accurate application of fees schedule and payment methodology as stated in the Managed Care contract. Submit actual payment variances through payer designated method for additional reimbursement due. Discrepancies in expected reimbursement identified as related to Epic registration are provided as feedback to the appropriate areas for training and correction. Report identified discrepancies in payment and trended issues of payer non-compliance and potential shortfall in expected revenue to Lead and Manager.
• Ability to manipulate data using Excel, applying intermediate to advanced functions (pivot tables, v-lookups and other complex formulas) to aid in validating payments. Ability to create projects necessary for pursuing payment variances and submitting trended issues for root cause analysis. Communicate with designated representatives regarding disposition of projects and maintain accountability for tracking of submitted projects through resolution.
• Monitor available reports and work queues daily to ensure research coordinators are reviewing unbilled charges timely. Monitor follow upwork queues to resolve unpaid claims. Resolve billing errors on posted charges and make corrections as needed on charges in charge review work queues.
• Train new research coordinators on navigating and completing the research workflows in Epic including registration, visit documentation and billing report completion. Provide feedback and continuing education to coordinators as needed. Communicate with Business Groups and Cash Department staff with questions as needed in a timely manner.
• Research misapplied payments utilizing People Soft and assist Cash Department in identifying payment posting resolution.
• Enter missing charges into Epic as identified and reported by the Audit Department or make corrections to posted transactions as appropriate.
• Act as a liaison between the Business Groups and Managed Care when escalating issues to a payer. Create and manage projects while communicating status through completion. Employ sound decision-making and professionalism with internal and external customers when addressing denial management, contract compliance and claims issues.
• Research payer coding and billing policies when analyzing contract payment compliance as related to variances utilizing online resources, procedural and diagnosis coding concepts and application of CMS, RBRVS or other payment methodologies. Communicate coding and billing errors to Business Groups which could affect collection rates or have compliance implications.
• All other duties as assigned
Temperament
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.
Qualifications
SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE
Skills, Knowledge, Abilities
• Possesses critical thinking, prioritization, and organizational skills.
• Analytical skills including the ability to visualize, articulate, conceptualize, and solve complex problems using logic and reason.
• Ability to read multiple formats of Payor Remittance Advice; provide explanation of Benefits and Overpayment Remittance Advice.
• Possesses excellent written communication and verbal/presentation skills, to interact at a high level with various levels of internal staff and representatives of payer organizations.
• Demonstrated self-motivation, ability to work independently with particular attention to detail and accuracy.
• Ability to manage multiple priorities and meet deadlines.
• Strong organization and data management skills essential to daily workflow.
• Knowledge of third party reimbursement preferred.
• Knowledge of SUFHCN Payer Contracts and negotiated reimbursement.
• Proficient in Epic Medical Management System.
• Proficient use of a Windows OS computer and office suite including advanced Excel skills.
Coding
• Proficiency with CPT (including HCPCS Level II) procedural coding, and ICD- diagnosis coding.
Clerical
• Ability to operate standard business equipment, e.g., copier and fax machine.
Experience Requirements
3 years - Medical billing/claims experience including coding, medical terminology, and third party reimbursement - required
3 years - Computer experience in medical billing - preferred
Up to 1 year - Managed Care Administration or Payer experience or claims processing experience - preferred
Up to 1 year - Epic system experience - preferred
1 year - Microsoft office experience essential (Proficient to expert skill in excel or ability to learn) - required
Education Requirements
High School Diploma orGED equivalent - required
Associates - preferred
Certification/Licensure Requirements
Certified Physician Coder (CPC) - required within 6 months
UFJPI is an Equal Opportunity Employer and Drug Free Workplace
