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.
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.
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.
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.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.