Insurance Reimbursement Manager

Salary depends on experience
Posted on 06/21/18
5 - 7 years experience
Healthcare
Salary depends on experience
Posted on 06/21/18

Department Profile:

Florida Hospital Patient Access/Guest Services – offers world class customer service and is the patient’s first impression at our mission-centric organization. As patient advocacy ambassadors, the Maitland team strives for excellence in patient experience, patient safety, throughput, regulatory compliance and ensures financial stability across the system. Our team of highly engaged registration and concierge staff assist patients, providing them with knowledge on medical insurance benefits and options to take care of patient financial responsibility. We work hand in hand with multiple departments throughout the campus to give our patients a seamless experience. With a focus on fostering talent we provide a wide range of opportunities to learn new skills and

Job Summary:

Under general direction, manages all functions of Billing and Insurance Reimbursement areas for assigned payor accounts. Maintains working relationship with all payers, staying in constant communication with provider representatives/contract managers. Monitors A/R by reviewing all payer account listing logs averaging from $30 million to $100 million per team, ensuring all accounts are processed and identifies barriers causing delay in payment. Reports all issues identified at quarterly JOC meetings/state meetings for Governmental Agencies. Performs managerial duties in absence of Director. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to Florida Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.



Knowledge, Skills, Education, & Experience Required:

  • Ability to serve as hospital liaison for patient and family in absence of patient representative.
  • Ability to use discretion when discussing personnel/patient related issues that are confidential in nature.
  • Ability to be responsive to ever-changing matrix of hospital needs and act accordingly.
  • Ability to give and follow written and verbal directions.
  • Self-motivator, quick thinker.
  • Ability to communicate professionally and effectively in English, both verbally and in writing.
  • Five (5) years experience (including two years supervisory experience) in Patient Access/Patient Financial Services Department or related area (registration, finance, collections, customer service, medical office, or contract management).
  • Four (4) year college degree (business, healthcare or health services administration, health information management, communications, finance, accounting, public administration, human resources, management, or marketing). (Preferred)

Job Responsibilities:

Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork as outlined in the organization’s Performance Excellence Program

  • Plans, develops, organizes, and manages all staff in daily operations of working payments, denials, correspondence and credit balances as appropriate. Responsible for all Insurance Reimbursement outcomes in assigned areas.
  • Monitors A/R by reviewing all payer account listing logs averaging from $30 million to $100 million per team, ensuring all accounts reaching days in A/R over 60, 90 and 150 are processed, and identifies barriers causing delay in payment. Follows up as appropriate with payers and contract manager for resolution. Reports all issues identified at quarterly JOC meetings/state meetings for Governmental Agencies.
  • Monitors all accounts pending DNFB and RMAU on a weekly basis ensuring timely billing per payer requirements and Federal Regulations; escalates as needed to resolve issues holding accounts.
  • Establishes and maintains working relationship with all payers, staying in constant communication with provider representatives/contract managers, ensuring contract language is followed, and if not, appropriate action is taken with contract management.
  • Focuses on process improvement strategies with special focus on Insurance Reimbursement outcomes to protect financial standing of Florida Hospital. Reviews all financial reports available, communicates outcomes to team and leadership timely, and provides accurate statistical records and reports. Holds self and staff accountable for individual and team goals set by PA/PFS Department. Evaluates staff at 90 day and annually in accordance with regulatory standards including giving constant feedback on productivity and any disciplinary action that is required including HR when appropriate.
  • Monitors all department changes/updates to ensure communication with team by holding weekly meetings including any continuing education that might be needed. Monitors mandatory CBLs to ensure they are completed as required.
  • Accountable for patient satisfaction and employee engagement scores, meeting goals set by Florida Hospital and PA/PFS department. Promotes an atmosphere of open communication for staff, clinical partners, and customers (patients, guests, families, staff, physicians, vendors, etc) at all times, assisting Customer Service Department in handling patient’s calls and complaints by responding to questions in a timely manner; monitors these complaints/concerns on a weekly basis.
  • Monitors all employees ensuring compliance with HIPAA and all other Federal Regulations are apriority followed.

If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Insurance Reimbursement Manager opportunity with Florida Hospital Maitland and apply online today.

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