Accept the Challenge…Make a Difference
University of Florida Jacksonville Healthcare, Inc. has supported the University of Florida's physician practice in Jacksonville and other northern Florida and southern Georgia communities since 1971. UFJHI provides a wide range of business services to one of the largest mixed specialty practices in the southeastern United States consisting of over 300 physicians working in 30 clinics. UFJHI is an exciting and challenging place to work. We really care about the communities and patients that we serve. Our employees work alongside nationally and internationally renowned physicians who are engaged in teaching and research as well as providing healthcare services. Primarily located in Jacksonville, Florida, UFJHI also offers a great north Florida lifestyle with countless recreational activities, museums, orchestras along with professional and amateur sports.
Scope of the Job
Applies strong analytical skills to identify payment variances compared to expected reimbursement from Contracted Managed Care Payers, Contracted Governmental Payers and Non-contracted miscellaneous Payers. Serve as the liaison between Business Groups, Shands Managed Care and contracted entities. Includes contract content review, application of appropriate contract terms, fee schedule(s), identification of trends and reporting trends to Manager of Special Projects for the purpose of reporting Payer Contract Compliance.
Analyst is responsible for assisting Lead and Manager of Special Projects in reconciling, problem solving, and collections for issues related to Contract Compliance and contracted Payer Performance.
The essential functions are the primary dimensions for performance review.
Request and Format data from Medical Management system capturing Profile data to determine true variance in payment for Team Lead assigned Carriers
Compare payment to Managed Care Contract, analyzing results as true variances requiring additional follow up compared to false variances, explained by billing or contractual criteria met
Pursue identified true variances, trending issues for reporting non-compliance of payer for use by UF in contract negotiations and balance billing payers for short fall in expected revenue.
Responsible for accurate application of fee schedules based on the payment methodology stated in the contract, using CMS, RBRVS or other payment methodologies when profiling contract payment compliance
Distinguish whether identified operational issues are related to internal or external data suppliers and act appropriately to provide root cause analysis and aid in carry out of resolution or interim work around action plan
Desire to learn and work collaboratively with Lead, Department Manager and Managed Care Contract Manager towards common goal
Identify and report discrepancy from expected reimbursement compared to fee schedule utilized by Payer and work with Lead, Manager and Managed Care to resolve
Inform Manager on the status of work and alert Manager of backlogs, trends or issues requiring immediate attention
Acts as liaison between Business Groups and Payer for designated Carriers or current structure of Department organization addressing denial management and contract compliance issues employing sound decision making skills and judgment determining when escalation to Lead and or Manager involvement is required
Attend Monthly Pre-Meetings with Lead Analyst Special Projects
Attendance and completion of summation report required monthly for assigned Payer Operations meetings as scheduled by Managed Care Jacksonville
Schedule and attend meetings as designated by Manager of Special Projects (Departmental, Conferences-off site meetings)
Summarize Operations Meetings within two Business days of attendance
Accountability through Matrix Management- Record statistical and historical chronology of events related to issues, projects, profile variance reports and contract compliance weekly
Works with Team Lead and Reporting Department to generate query requests for isolation of invoices- includes some knowledge of Query language components
Respond to communication by reaching out to appropriate points of contact requiring support with payer contract compliance
Communicate with Payer designated representatives regarding disposition of open balances, denial issues, contract variances and root cause analysis
Utilize Infonet and Payer Sponsored Websites for research and information
Interact, conveying a professional image and rapport with internal customers and external customers (physicians, insurance carriers, business group manager, and directors)
Flexibility to work various hours, including weekends and evenings based on business need
Maintain high level of confidentiality in regards to sensitive information
Maintain above average attendance percentages
Investigate and respond including rebuttal on findings related to a Bulk refund project when request for refund is generated by a contracted carrier- Information provided to Refund Department
Perform special projects and other duties as assigned by the Lead Analyst or Department Manager
Must be able to perform under stress when confronted with emergency, critical, or unusual situations. Must be capable of dealing with periodic cyclical workload pressures and levels of responsibility. Required to make independent judgments without supervision. Must be able to make generalizations, evaluations, or decisions based on sensory or judgmental criteria. Must have the adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure. Requires the ability to work with people beyond giving and receiving instructions.
Strong analytical, Data Management and problem solving skills.
Effective interpersonal and communication skills.
Excellent oral, written, media presentation and communication skills.
Ability to Manage and maximize operating efficiency without need for flexibility decreasing momemtum
Knowledge of SUFHCN Payer Contracts and negotiated reimbursement.
Ability to operate standard business equipment, e.g., copier, fax machine, and microfilm retriever.
Able to be assertive and detail oriented.
High level of decision making ability with outstanding organizational skills.
Make decisions independently with minimal supervision, self motivated and goal oriented
Ability to manage time effectively and meet deadlines imposed by either internal and external requirements (claim filing, reports, contract compliance)
Website navigation required, webmaster skills preferred, including desktop publishing as the preferred software
Ability to read Multiple formats of Payer Remittance Advice, Explanation of Benefits and Overpayment Remittance Advice
Employ sound decision making when communicating educational information pertaining to billing guidelines and the impact it has on the overall organization
Strong organization and data management skills essential to daily workflow
Ability to move from one task to another with minimal disruption
Assisting in trending and benchmark strategies for contract terms and negotiations
Proficient with use of all Microsoft Office Suite applications with particular emphasis in Excel
Proficient in IDX Medical Management System
Knowledge of CPT-4 and ICD-9 Coding and Medical Terminology.
10 key proficiency desired.
Light typing (35 WPM).
Preferred 3-5 years Health care billing experience in medical billing or related position.
Computer experience in medical billing required, prior IDX system experience preferred
CRT and PC experience essential (proficient to expert skill in excel or ability to learn)
Preferred Managed Care Administration or Payer experience or claims processing experience
Education and Certifications
High School Diploma /GED equivalent required. Associate’s Degree Preferred. CPC or other coding credential preferred
University of Florida Jacksonville Healthcare Inc. - 14 months ago