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CLAIMS RESOLUTION SPECIALIST

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Posting Details

Posting Details

Position Title CLAIMS RESOLUTION SPECIALIST
Job Category Clerical
Posting Number 20172476
Position Status Active-Full-Time
Positions Supervised

N/A

Customer Service Statement

CUSTOMER SERVICE: Demonstrate adherence to the Group’s Customer Service Standards designed to support the mission of USF Health: enhancing life by improving health through research, education and healthcare. Our commitment is to improve the full spectrum of health, from the environment, to the community, to the individual. Together, through talent and innovation, USF Health is developing real-world solutions to reach our shared value – making life better.

Position Summary

Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payors to ensure reimbursement. Reviews assigned accounts, determines appropriate action to resolve outstanding balances. Works within the established guidelines of the department’s procedures, policies and goals. Conduct studies/special projects to resolve outstanding accounts receivable.

Position Requirements

Must be fluent and able to conduct business in English which includes reading, writing and speaking.

Educational Requirements: High School Education, Associates Degree Preferred.

Experience Requirements: Two-year experience in physician billing and collection experience preferred. Knowledge of CPT and ICD guidelines required. PCIS software experience preferred.

Business Skill Requirements: Strong analytical and intuitive skills, self-motivated with the ability to multi-task and remain organized. Personal computer skills.

  • Requirements reflect the minimum level necessary to be eligible for this position. Equivalent combinations of education and experience may be considered.
Customer Service Performance

CUSTOMER SERVICE PERFORMANCE EXPECTATIONS: Courteous and helpful behavior towards patients, physicians, coworkers and external customers; professional and efficient verbal and written communications; accomplishing tasks through teamwork and initiative; and ensuring a timely and thorough response to complaints and/or critiques, and anticipating the needs of all you come in contact with.

Physical Demands
Special Instructions to Applicants
Location FOB-USF TAMPA CAMPUS
Department Name RCO-IRU
Work Schedule Summary

Specific Duties and Responsibilities

Percentage 45
Duties

Contact insurance carriers/third party regarding status and payment. Research Medicare, Medicaid, and all other third party payments and denials by reviewing EOBs or denial Work Files. Identify accounts that are approaching filing limit deadlines and work accounts to ensure claim is successfully adjudicated prior to any filing deadlines. Determine appropriate action for resolution of outstanding balance. Check invoices to ensure compliance with CPT and ICD9 coding before submissions.

Percentage 20
Duties

Process appeals and denials according to internal guidelines. Identify claims payment errors/trends, research relevant third party billing requirements as they pertain to specific third party payors. Resubmit denied claims when appropriate electronic or paper resubmission. Report reimbursement or denial trends to the supervisor.

Percentage 15
Duties

Request and review information such as medical records, EOBs, charge tickets, etc., for account resolution as needed for appeals, insurance requests and duplicate charges. Update registration and the FSC list. Submit charge corrections or adjustments when required.

Percentage 5
Duties

File both primary and secondary claims to the insurance carriers with appropriate records and EOB’s.

Percentage 5
Duties

Keep current with state and federal regulations guidelines as reported.

Percentage 5
Duties

Inquire about recipient through Medifax or Medicare part A on-line. Update and correct registration.

Percentage 5
Duties

Other duties as requested by supervisor.

Posting Specific Questions

Required fields are indicated with an asterisk (*).

  1. * Do you have experience using CPT and ICD-9 and/or ICD-10?
    • YES
    • NO
  2. * Have you used online insurance portals for eligibility and claims status?
    • YES
    • NO
  3. * Do you have experience in insurance collections, including the process of appealing claims?
    • YES
    • NO

Applicant Documents

Required Documents
  1. Resume
Optional Documents
  1. Cover Letter
  2. Letter of Recommendation 1
  3. Letter of Recommendation 2
  4. Letter of Recommendation 3