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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 20172502
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 to determine appropriate action to resolve such as: perform status inquiries on no response claims, appeals to 3rd party payers based on various rejection reasons such as eligibility, authorizations, timely filing, and coding denials. 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’s experience in physician billing and collection experience required. Extensive knowledge of payer policies and guidelines, LCD/NCD guidelines, MUEs, as well as NCCI and McKesson coding edits. Extensive knowledge of Revenue Cycle processes, rejection codes, interpreting 837 and 835 submissions, and demonstrate the ability to identify opportunities to reduce denials and increase payment. Understanding of CPT and ICD-10 guidelines required. PCIS/Allscripts and EPIC software experience highly preferred.

Business Skill Requirements: Strong analytical and intuitive skills, self-motivated with the ability to multi-task and remain organized. Microsoft Office experience primarily Excel is preferred.

  • 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 REV CYCLE OPERATIONS
Work Schedule Summary

Specific Duties and Responsibilities

Percentage 45
Duties

Contact insurance/third party payers regarding status and payment. Research Medicare, Medicaid, and all other third party payments and denials, by reviewing EOBs, payer policies and guidelines, and department policies and workflows. 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 ICD-10 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 payers. Resubmit denied claims when appropriate, via electronic or paper resubmission. Report reimbursement or denial trends to the manager.

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. 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 patient coverage through various on-line insurance portals. Update and correct registration.

Percentage 5
Duties

Other duties as requested.

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