Insurance Reimbursement Lead – Medicaid & Government Billing – Maitland
Florida Hospital Maitland seeks to hire Insurance Reimbursement Lead 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. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.
Florida Hospital Patient Access/Guest Services – offers world class customer service and is the patient's first impression at our mission-centric organization. As patient advocacy ambassadors, the Maitland team strives for excellence in patient experience, patient safety, throughput, regulatory compliance and ensures financial stability across the system. Our team of highly engaged registration and concierge staff assist patients, providing them with knowledge on medical insurance benefits and options to take care of patient financial responsibility. We work hand in hand with multiple departments throughout the campus to give our patients a seamless experience. With a focus on fostering talent we provide a wide range of opportunities to learn new skills and grow professionally through individual development plans.
8:00am – 5:00pm / Monday – Friday
The Insurance Reimbursement Lead is responsible for processing insurance and billing 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. Performs testing for system upgrades/changes. Provides quality assurance for like job functions when necessary. 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.
Uses discretion when discussing employee/patient related issues that are confidential in nature.
Responsive to ever-changing matrix of business needs and acts accordingly.
Typing skills equal to 30 words per minute.
Proficiency in performance of basic math functions.
Communicates professionally and effectively in English, both verbally and in writing.
Proficiency in Microsoft Office products, such as, Word and Excel.
Strong analytical and research skills.
HCFA1500 formats relative to regulatory standards in claims (paper and/or electronic) processing.
Excellent knowledge of ICD, CPT, HCPS coding, and medical terminology.
Two years of experience in a Revenue Cycle department or a related field, such as, registration, finance, collections, customer service, medical, or contract management.
At least one year of experience in lines of business, such as, HMO, PPO, Medicare, Medicaid, etc.
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. When necessary, participates in conference calls, accounts receivable reporting, and compiles the issue report to expedite resolution of accounts. Examines contracts 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, maintains established goal(s), and notifies Manager of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments, etc.) 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 and determines appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), contacts 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 Manager if necessary. Processes administrative and medical appeals, refunds, reinstatements and rejections of insurance claims.
Remains in consistent daily communication with team members, regarding new process education and disciplinary actions, and with Manager regarding all aspects of assigned projects. Effectively prioritizes work, identifies, and resolves complex concerns in a professional manner, and works in a team environment to achieve a common goal.
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 Manager. Provides continuing education to all team members on process and A/R requirements.
When necessary, assists with coordinating, processing and posting of all payments (including cash and mail receipts) accurately within established department standards.
Handles special projects and testing for system upgrades/changes as assigned by management. Provides quality assurance for like job functions when necessary. Makes recommendations by performing root cause analysis regarding any system-related problems to enhance efficiencies and savings to the department.
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 Lead opportunity with Florida Hospital Maitland and apply online today.
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.