Insurance Receivable Specialist II
Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for insurance receivables collections, denials resolution and internal/external customer service. Account portfolio may include accounts less complex in nature. This position is not responsible for providing patient care.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
Performs insurance follow-up and denial resolution on outstanding claims.
Performs contract compliance on outstanding claims, ensuring timely and appropriate reimbursement based on contract terms.
Performs payment compliance reviews and resolutions based on projects focused by payer, service, entity, trend, etc., as assigned by unit leader.
Ensures appropriateness of patient responsibility, as assigned by payer/contract/benefit.
Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review and coordination with UR and/or attending physician.
Acts as patient advocate in the resolution of balances.
Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned.
Escalates claim issues internally to other key departments including Coding, Billing, Charging, Contracting, etc.
Knowledge / Skills / Abilities
The ability to express information in a clear and understandable manner.
Ability to organize and prioritize work to meet productivity expectations and/or deadlines.
Ability to identify root cause of issue and design logical approach for resolution.
Ensures accuracy and thoroughness in accomplishing tasks.
Takes ownership for the quality and timeliness of work and can achieve result with little oversight.
Promotes cooperation and commitment to team goals.
Ability to solicit and act on constructive feedback, challenge oneself and demonstrate resilience in the face of opposition.
Provides outstanding service through empathy, issue resolution and follow through.
Qualifications
Required
Three years of medical billing experience, or equivalency.
Qualifications (Preferred)
Preferred
Understanding of Medical billing terminology or equivalent.
Demonstrated claims knowledge through AAHAM certification, or equivalency.
One year of coding experience using ICD-10.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
Physical Requirements
Color Determination, Listening, Manual Dexterity, Near Vision, Reaching, Sitting, Speaking, Standing
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for insurance receivables collections, denials resolution and internal/external customer service. Account portfolio may include accounts less complex in nature. This position is not responsible for providing patient care.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
Performs insurance follow-up and denial resolution on outstanding claims.
Performs contract compliance on outstanding claims, ensuring timely and appropriate reimbursement based on contract terms.
Performs payment compliance reviews and resolutions based on projects focused by payer, service, entity, trend, etc., as assigned by unit leader.
Ensures appropriateness of patient responsibility, as assigned by payer/contract/benefit.
Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review and coordination with UR and/or attending physician.
Acts as patient advocate in the resolution of balances.
Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned.
Escalates claim issues internally to other key departments including Coding, Billing, Charging, Contracting, etc.
Knowledge / Skills / Abilities
The ability to express information in a clear and understandable manner.
Ability to organize and prioritize work to meet productivity expectations and/or deadlines.
Ability to identify root cause of issue and design logical approach for resolution.
Ensures accuracy and thoroughness in accomplishing tasks.
Takes ownership for the quality and timeliness of work and can achieve result with little oversight.
Promotes cooperation and commitment to team goals.
Ability to solicit and act on constructive feedback, challenge oneself and demonstrate resilience in the face of opposition.
Provides outstanding service through empathy, issue resolution and follow through.
Qualifications
Required
Three years of medical billing experience, or equivalency.
Qualifications (Preferred)
Preferred
Understanding of Medical billing terminology or equivalent.
Demonstrated claims knowledge through AAHAM certification, or equivalency.
One year of coding experience using ICD-10.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
Physical Requirements
Color Determination, Listening, Manual Dexterity, Near Vision, Reaching, Sitting, Speaking, Standing