University of Florida Jacksonville Healthcare, Inc.
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Special Projects Analyst
at University of Florida Jacksonville Healthcare, Inc.
Combines strong analytical skills with knowledge of managed care and billing concepts to identify variances in payment compared to expected reimbursement from contracted Managed Care and Governmental Payers. Analyst is responsible for assisting Lead and Manager of Special Projects in problem solving, reconciling and collection of payment variances for issues related to contract compliance and contracted payer performance using online tools, Excel, written and verbal communication. Analyst serves as the liaison between Business Groups, UF Health Managed Care and Payers for the purpose of resolving individual and trended issues. Includes contract content review, application of appropriate contract terms, fee schedules, identification and reporting of trends to Manager. Responsible for Research Department claims and training of research coordinators on Epic billing process.
Analyze invoices in Epic follow-up workqueues to determine contracted insurance payment compliance by accurate application of fee schedule and payment methodology as stated in the Managed Care contract. Submit actual payment variances through payer designated method for additional reimbursement due. Discrepancies in expected reimbursement identified as related to Epic registration are provided as feedback to the appropriate areas for training and correction. Report identified discrepancies in payment and trended issues of payer non-compliance and potential shortfall in expected revenue to Lead and Manager.
• Ability to manipulate data using Excel, applying intermediate to advanced functions (pivot tables, v-lookups and other complex formulas) to aid in validating payments. Ability to create projects necessary for pursuing payment variances and submitting trended issues for root cause analysis. Communicate with designated representatives regarding disposition of projects and maintain accountability for tracking of submitted projects through resolution.
• Monitor available reports and workqueues daily to ensure research coordinators are reviewing unbilled charges timely. Monitor follow up workqueues to resolve unpaid claims. Resolve billing errors on posted charges and make corrections as needed on charges in charge review workqueues.
• Train new research coordinators on navigating and completing the research workflows in Epic including registration, visit documentation and billing report completion. Provide feedback and continuing education to coordinators as needed. Communicate with Business Groups and Cash Department staff with questions as needed in a timely manner.
• Research misapplied payments utilizing People Soft and assist Cash Department in identifying payment posting resolution.
• Enter missing charges into Epic as identified and reported by the Audit Department or make corrections to posted transactions as appropriate.
• Act as a liaison between the Business Groups and Managed Care when escalating issues to a payer. Create and manage projects while communicating status through completion. Employ sound decision-making and professionalism with internal and external customers when addressing denial management, contract compliance and claims issues.
• Research payer coding and billing policies when analyzing contract payment compliance as related to variances utilizing online resources, procedural and diagnosis coding concepts and application of CMS, RBRVS or other payment methodologies. Communicate coding and billing errors to Business Groups which could affect collection rates or have compliance implications.
Skills, Knowledge & Abilities
• Analytical skills including the ability to visualize, articulate, conceptualize, and solve complex problems using logic and reason.
• Ability to read multiple formats of Payor Remittance Advice; provide explanation of Benefits and Overpayment Remittance Advice.
• Possesses excellent written communication and verbal/presentation skills, to interact at a high level with various levels of internal staff and representatives of payer organizations.
Attention to Detail
• Demonstrated self-motivation, ability to work independently with particular attention to detail and accuracy.
• Ability to manage multiple priorities and meet deadlines.
• Strong organization and data management skills essential to daily workflow.
• Knowledge of third party reimbursement preferred.
• Knowledge of SUFHCN Payer Contracts and negotiated reimbursement.
• Proficient in Epic Medical Management System.
• Proficient use of a Windows OS computer and office suite including advanced Excel skills.
• Proficiency with CPT-4 (including HCPCS Level II) procedural coding, and ICD-10 diagnosis coding.
• Ability to operate standard business equipment, e.g., copier and fax machine.
Length of Experience
Type of Experience
Health care billing experience in medical billing or related position
Computer experience in medical billing
Up to 1 year
Managed Care Administration or Payer experience or claims processing experience
Up to 1 year
Epic system experience
CRT and PC experience essential (proficient to expert skill in excel or ability to learn)
Education & Certifications
Program of Study
High School Diploma or GED equivalent
Certified Professional Coder (CPC)
within 1 year