Insurance Reimbursement Specialist II – PFS Billing – Maitland
Maitland seeks to hire Insurance Reimbursement Specialist II who will embrace our mission to extend the healing ministry of Christ.
Established in 1908, Florida Hospital is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. (This role is located at the 900 Trickel Building in Maitland, FL).
The Medicaid and Government Insurance Reimbursement team at Florida Hospital Maitland includes Billing Representatives, as well as their support and management staff. The Medicaid and Government Insurance Reimbursement department consists of a great team of individuals responsible for collecting all insurance dollars for the services provided to Florida Hospital patients. This is accomplished by making frequent and effective status calls to Medicaid and Government or via online requests. In an effort to resolve outstanding accounts, the Insurance Reimbursement team tracks and trends Medicaid and Government payments in order to provide feedback to Medicaid and Government Payors for improved future performance. This information is often utilized by various departments within Florida Hospital when making operational decisions. We strive to build a working relationship with Medicaid and Government Payors in an effort to create a partnership for success.
8:00am – 5:00pm / Monday - Friday
Under general supervision, is responsible for processing insurance and billing insurance in a timely manner. Reviews assigned electronic claims and submission reports. Resolves and resubmits rejected claims appropriately as necessary. Processes daily and special reports, unlisted invoices and letters, error logs, stalled reports and aging. Performs outgoing calls to patients and insurance companies to obtain necessary information for accurate billing. Answers incoming calls from insurance companies requesting additional information and/or checking status of billings. Adheres to all company policies and procedures. Adheres to Florida Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Ability to use discretion when discussing personnel/patient related issues that are confidential in nature.
Ability to be responsive to ever-changing matrix of hospital needs and act accordingly.
Ability to communicate professionally and effectively in English, both verbally and in writing
Proficiency in performance of basic math functions.
Strong analytical and research skills
One year of experience in a Revenue Cycle department or related areas such as registration, finance, collections, customer service, medical, or contract management
High school diploma or GED (Preferred)
Licensure, Certification, or Registration Required:
Demonstrates through behavior Florida Hospital's Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization's Performance Excellence Program
Works with insurance payers to ensure proper reimbursement on patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts.
Examines contract to ensure proper reimbursement, educates team of inconsistencies in processing, including disciplinary discussions if necessary, and any changes to contract identified.
Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments) to appropriately work patient accounts. Assists Customer Service with patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc.
Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. Sends initial or secondary bills to Insurance companies.
Documents billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary. Processes administrative and medical appeals, refunds, reinstatements and rejections of insurance claims.
Remains in consistent daily communication with team members, including new process education, disciplinary actions, Reimbursement Lead and Reimbursement Manager regarding all aspects of assigned projects.
Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Manager. Trains new staff, performs audits of work performed, and communicates progress to appropriate Supervisor. Provides continuing education of all team members on process and accounts receivable (A/R) requirements.
Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Insurance Reimbursement Specialist II opportunity with Maitland and apply online today.
Insurance Reimbursement, Specialist II, Patient Financial Services, Maitland
Florida Hospital is dedicated to improving lives not only in Central Florida, but also around the world. As a destination hospital, we are committed to serving the health care needs of our patients with a holistic approach to heal the mind, body and spirit. We strive to be the hospital of choice for patients, physicians and employees. Over the last 100 years, Florida Hospital’s mission remains unchanged: to extend the healing ministry of Christ.