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Revenue Cycle Specialist in Daytona Beach, FL at Vaco

Date Posted: 3/1/2019

Job Snapshot

Job Description

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 Florida Hospital Central Florida Division - North Region.


* Responsible for performing and processing accurate billing procedures for all payors, electronically through SSI (a medical claims management system that assists Florida Hospital 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.
* Assists Customer Service area with patient concerns/questions to ensure prompt and accurate resolution is achieved. Ensures we foster a team-spirited approach while interacting with co-workers, peers, management, etc. Stays committed to delivering superior customer service to our patients.
* Analyzes previous account documentation, to determine appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), not limited to calling Patients, Insurers or Employers, as appropriate. Remits initial or secondary bills to insurance companies immediately following payment from the primary insurance payer.
* Coordinates with multiple departments to resolve denials and payment discrepancies including but not limited to Case Management, Billing, Coding, and Refunds departments.
* Key members of the Revenue Cycle team will also be responsible for, daily, certain specific functions.
o Monitoring for and processing 24 and 72 hour overlapping accounts.
o Monitoring and processing status changes.
* Applies appropriate adjustments to accounts because of the audit. Analyzes previous account documentation to determine the appropriate write off code of medically denied charges for the right reason.
* Reviews follow-up codes submitted to other departments daily for appealed claims and communicates with departments to ensure timely response.
* Performs comprehensive and accurate follow-up on each account to ensure prompt resolution is achieved in a timely manner. Documents steps taken as well as the result and next step needed to resolve the assigned payment.
* Maintains accurate and comprehensive records of each phase of appeal. Works appeal denials daily to ensure accounts are processed to next appeal level in a timely manner or determination is made for acceptance of denial.
* Facilitates appeals on assigned accounts when appropriate and as specified in payor contract to receive payment for denied services.
* Monitors accounts for incorrect insurance address/information and follows up on accounts that have been billed to payors to review for timely payment or denial. Re-classes daily and resubmits corrected claim as appropriate.
* Reviews incoming correspondence and customer service requests within 24 hours of receipt to appropriately resolve issues and promote positive relationships with patients and payors.
* Completes account follow up daily, maintaining established goal (s), and notifies Lead Rep, when necessary, of issues preventing achievement of such goal(s).
* Documents the billing, follow-up and/or collection step(s) and all measures taken to resolve assigned accounts, including escalation to Manager if necessary.
* Other duties as assigned.


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


* 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.


1. Exhibits ICARE values and loving care in all interpersonal contacts. Establishes and maintains courteous, tactful and professional level of interpersonal skills necessary to deal effectively with customers and populations served, including:
* Patients
* Guests
* Co-Workers
* The public
* Medical staff
* External business associates

2. Demonstrates effective oral and written communication skills; maintains required level of confidentiality; interacts effectively with employees at all levels.

3. Conforms to all Adventist Health System and Florida Hospital East Florida Region policies and procedures including but not limited to:
* Mission/Vision/Values and Philosophy
* Customer Service Pledge
* Corporate Compliance
* Rules of Conduct as outlined in the "Guidelines for Employees" handbook
* No Smoking
* Dress Code

4. Establishes and maintains a history of regular attendance; makes appropriate use of PDO, and observes department call-in procedures for absence; establishes and maintains punctual work habits. Exhibits timely arrival and departure and dependable time habits including meal and other breaks.

5. Attends/participates in mandatory facility-wide and department training/meetings as required including but not limited to: department Huddles, annual education, safety training, Town Halls, etc. Is able to demonstrate and apply knowledge of fire, safety, security, disaster procedure regulations and National Patient Safety Goals as presented in orientation, outlined in safety manual, and as pertains to each work area.

6. Supports departmental and organizational Mission through:
* Embracing and demonstrating a commitment to Sacred Work
* Appropriate use of resources
* Providing assistance to team members
* Accepting work or schedule assignments
* Participating in process and performance improvement as required

7. Required to respond to emergency situations (i.e., disasters, hurricanes, etc.) by reporting to department and staying until the crisis is over or position is covered by incoming personnel. This is a mandatory requirement. Refusal to respond may result in termination.


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