Job Description

Job Description

Description
Revenue Cycle Specialist AdventHealth Daytona Beach

Location Address: 770 W Granada Boulevard Ormond Beach, FL 32174

Top Reasons To Work At AdventHealth Daytona Beach

Career growth and advancement potential

Health Insurance Coverage

High quality of life with low cost of living on the shores of sunny Daytona Beach, FL.

Work Hours/Shift:

Full Time, Day

You Will Be Responsible For:

* Responsible for performing and processing accurate billing procedures for all payors, electronically through SSI (a medical claims management system that assists AdventHealth Patient Financial services (FH PFS) insurance reimbursement team with claims editing and validation). Works independently, meeting time and daily deadlines in an accurate and efficient manner, communicating any issues to leadership.
* Ensures expeditious and accurate insurance reimbursement for all Government and Managed Care payors. Updates a high volume of daily claims appropriately in SSI system. Appropriately determines, initiates, and follows through on the status of claims in SSI, such as place on hold, delete, or assigns account error to responsible, supporting department. Documents billing, follow-up and/or collections step(s) that are taken as well as the result and next step needed to resolve the assigned payment
* Monitors and audits status of errors assigned to other areas or PFS teams for all payors daily, ensuring timely follow up and expeditious billing. Communicates with key management staff and supporting department partners effectively and professionally, to ensure key metrics are being addressed timely. Assist in identifying key trends as applicable or opportunities for improvement.
* Maintains communication between external or contracted agencies, business vendors and partners, FH department (i.e. Revenue Management, Laboratory, Contract Management, Case Management, Payors, etc.) ensuring compliance between external relationships, knowledge of contractual terms, and performance protocols. Informs leadership of any foreseeable issues with partners. Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved.
* Processes and records agency audit notifications and responds in designated timeframe to ensure compliance with government and/or contractual requirements for timely response.
* Works all assigned insurance payers to ensure proper reimbursement on patient accounts to expedite resolution. Processes medical, administrative, technical appeals, request refunds when applicable, and rejections of insurance claims. Ensures proper escalation is met when account receivable is not collected in a timely manner.
* Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues. Responds to written correspondence received from Payer and/or Patients. Is responsible to stay current on all active, assigned accounts which prevents abandonment, uncollected account receivables.

Qualifications
What You Will Need:

KNOWLEDGE AND SKILLS REQUIRED:

* Computer/data entry skills required. Proficiency in performance of basic math functions. Communicates professionally and effectively, both verbally and in writing

EDUCATION AND EXPERIENCE REQUIRED:

* High School diploma or GED required.
* One-year experience in healthcare, finance, accounting, banking, insurance, or related fields.
* One year of college can be substituted for experience.
* One-year experience in healthcare claims processing or collections preferred.

Job Summary:

The Revenue Cycle Specialist will be responsible for follow up on Third Party Claim Reimbursements for the identification, billing and collection of payments. Under the direction of the Manager will be responsible for handling all functions relative to these areas. Responsible for providing support and service to all AHS Facilities in the AdventHealth Central Florida Division North Region.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.