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The University of Miami/UHealth Central Business office has an exciting opportunity for a full-time Contract Reimbursement Representative to work in Miami, FL. The Contract Reimbursement Representative is responsible for ensuring accurate reimbursement practices. In addition, this person will identify and report any issues identified
Primary Duties and Responsibilities (For Non-exempt Employees Include Percent of Effort)
Review and analyze credits within the assigned WQs for proper resolution. Involving payers, patient and other entities.
Review and interpret contract rates to ensure proper reimbursement, as well as EOBs.
Serve as a liaison between the Credit Balance Unit and external departments, vendors, as well as patients and Third Party Companies to address reimbursement related inquiries.
Review refund requests submitted by payers and patients to ensure validity. Submit appeal letters within the alloted time. Apply Florida Statutes accordingly to commercial payers.
Assess patient's coverage and eligibility. As well as pre-authorizations. • Process refunds via check, credit card portal and wire transfer.
Provide ongoing in-service training for on-boarding staff and vendors. • Performs other duties as assigned.
This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.
Educatio n Requirements (Essential Requirements)
High School graduate. Work Experience Requirements (Essential Requirements)
One year (1) of medical billing and collections experience.
Epic experience preferred. Job descriptions are not intended, and should not be construed to be an exhaustive lists of all responsibilities, skills, and efforts or working conditions associated with a job. Management reserves the right to revise duties as needed.
Knowledge, Skills, and Abilities
Excellent verbal and written communication skills in English.
Strong organizational skills and ability to multi-task and deal with difficult situations.
Must have a knowledge and understanding of state/federal hospital regulations & medical terminology.
Must have excellent critical thinking, analytical, problem solving, interpersonal, communications & customer service skills.
Work under minimal supervision, function in high stress environment, multi-task & establish priorities.
Knowledge of Medicare, Medicaid, Managed Care, Third Party Payer System and Florida Prompt Pay Law.
Ability to maintain a professional demeanor when communicating with staff, patients and all outside contacts.
Must be able to maintain confidentiality to patient information
Any relevant education, certifications and/or work experience may be considered.
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The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.
