- Identifies and performs a root cause analysis for any systemic issues associated with adjudicated claims that may impact upstream billing to the health plans and provides follow-up with internal and external parties as applicable to address reasons for denial.
- Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines, and the ability to communicate and work with payers to get claims resolved and paid accurately.
- Review payer 277/277CA and 835 responses and adjust the claim accordingly.
- Accurately and efficiently review patient demographic and insurance data in our proprietary billing system as it relates to covered services and areas.
- Files and tracks the progress of appeals and reconsiderations of claim decisions by assigned payer(s).
- Identifies and communicates trends and patterns that reflect deficiencies in the revenue cycle process that require multi-department collaboration and/or systematic development.
- Serve as the point of contact for all inquiries from health plans, while providing superior customer service and effectively communicating with insurance companies to ascertain claim status and specific claim dispositions.
- Maintain the strictest confidentiality; adhere to all HIPAA (Health Insurance Portability and Accountability) and other industry rules and regulations.
- College education in health services administration, accounting, business, or similar discipline or equivalent experience.
- Knowledge of medical billing and coding.
- Certified Coding Specialist (CCS)/Certified Coder Associate (CCA)/AAPC - CPC Certified Professional Coder desirable.
- Minimum of 1 year experience in end-to-end revenue cycle management.
- Experience with clearinghouse platforms and RCM systems, preferably Waystar, Optum, and Availity.
- Experience working independently and as a member of various teams and/or workgroups.
- Strong computer skills and knowledge of MS Office products with intermediate Excel level.
- Ability to quickly navigate between different system platforms.
- Strong written and verbal communication skills.
- Strong organizational skills, problem-solving, and analytical skills.
- Acute attention to detail.
- Bilingual (English/Spanish) is desirable.
- Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification before acting; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Writes clearly and informatively, Edits work for spelling and grammar.
- Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
- Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
-
Revenue Cycle Specialist
2 weeks ago
Alivi Miami, United StatesJob Description · Job DescriptionSummary: · The primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitati ...
-
Revenue Cycle Specialist
4 weeks ago
Alivi Miami, United StatesSUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resoluti ...
-
Revenue Cycle Specialist
4 weeks ago
Alivi Miami, United StatesJob Description · Job DescriptionSUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating t ...
-
Revenue Cycle Specialist
1 week ago
Firstsource Solution USA Miami, United StatesLocation: REMOTE- Revenue Cycle Billing · Hours: Monday through Friday 8:00am - 5:00p · **GENERAL SUMMARY**: · The goal of the Revenue Cycle Billing Specialist is to successfully collect on aging medical insurance claims. · **Essential Duties and Responsibilities**: · - File clai ...
-
Revenue Cycle Specialist II
3 weeks ago
MIami Beach Community Health Center Miami, United StatesJob Description · Job Description***SEEKING A CERTIFIED REVENUE CYCLE SPECIALIST II*** · Primary Accountability · The Revenue Cycle Specialist II will assist the Revenue Cycle Director and the Revenue Cycle Manager in operations. · Primary Responsibilities · 1. Assist the Revenue ...
-
Sr. Revenue Cycle Audit Specialist
1 week ago
UOMUOMUS Miami, United States OTHERCurrent Employees: · If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review ...
-
Sales Representative
2 weeks ago
Abbott Miami, United StatesThe Opportunity · We are hiring a Point of Care Solutions Specialist in our Abbott Point of Care (APOC) Division selling to hospitals in the South Florida Territory. The Point of Care Solution Specialist works independently within an assigned territory leading commercial exec ...
-
Clinical Engineer Equipment Specialist
3 weeks ago
Nicklaus Children's Health System Miami, United States OTHERJob Summary · Responsible for providing medical equipment technical support to staff, patients, and administrators relating to Nicklaus Children's Health System's wide life cycle management of medical equipment and systems. Performs routine tasks involved in the installation, ma ...
-
Business Development Manager + Hirgin now
4 weeks ago
Hightekers Miami, United States Full timeBusiness Development Manager + Hirgin now industry Miami · Who are we? · Hightekers was founded with the idea of supporting IT and Engineer freelancers to do what they do best. We are on a mission of supporting them with all the administrative management, and leave them the i ...
-
Head of Regulatory Affairs and QMS
2 weeks ago
apoqlar Miami, United StatesMake a positive impact in the global healthcare community with cutting-edge medical mixed reality technology. · About Us: · apoQlar is the developer of a medical mixed reality platform that is revolutionizing how medicine is practiced, experienced, learned, and shared. Our flag ...
-
CEO - The Surgery Center at Doral
3 weeks ago
SCA Health Miami, United StatesCEO - The Surgery Center at Doral · JOB_DESCRIPTION.SHARE.HTMLCAROUSEL_PARAGRAPH · JOB_DESCRIPTION.SHARE.HTMLDoral, Florida · The Surgery Center at Doral · Business Ops · Regular · Full-time · 1 · USD $100,000.00/Yr. · USD $125,000.00/Yr. · 34177 · Job Description · Overview · T ...
-
CEO - The Surgery Center at Doral
6 days ago
SCA Health Miami, United StatesCEO - The Surgery Center at Doral · JOB_DESCRIPTION.SHARE.HTMLCAROUSEL_PARAGRAPH · JOB_DESCRIPTION.SHARE.HTMLDoral, Florida · The Surgery Center at Doral · Business Ops · Regular · Full-time · 1 · USD $100,000.00/Yr. · USD $125,000.00/Yr. · 34177 · Job Description · Overview · T ...
-
IVF Lab Assistant
6 days ago
CCRM Fertility Miami, United States Full timeCome join CCRM Fertility, a global pioneer in fertility treatment, research, science, specializing in IVF, fertility testing, egg freezing, preimplantation genetic testing, third party reproduction and egg donation. As a member of CCRM Fertility's diverse team of professionals, y ...
-
Bilingual Consumer Lending Sales Specialist
2 weeks ago
Purpose Financial Miami, United States Full timeAddress : 900 SW 67th Ave., Ste. 35, Miami, Florida, United States · Bi-Lingual Spanish is a plus · Since 1997, Advance America has helped millions of hardworking people with a variety of personalized financial solutions. We are a nationally recognized, fully licensed financial ...
-
staff assistant
2 weeks ago
State of Florida Miami, United StatesRequisition No: · Agency: Department of Health · Working Title: STAFF ASSISTANT · Pay Plan: Career Service · Position Number: · Salary: $32, $34,000.00 · Posting Closing Date: 05/27/2024 · Total Compensation Estimator Tool · OPEN COMPETITIVE · Your Specific Responsibilities: ...
-
Clinical Engineer Equipment Specialist
3 weeks ago
Nicklaus Children's Hospital Coconut Grove, United States· Job Summary · Responsible for providing medical equipment technical support to staff, patients, and administrators relating to Nicklaus Children's Health System's wide life cycle management of medical equipment and systems. Performs routine tasks involved in the installation, ...
-
Payment Posting Specialist
1 week ago
Gastromed, LLC Miami, United StatesJob Description · Job DescriptionJOB TITLE: Payment Posting Specialist · REPORTS TO: Revenue Cycle Manager · FLSA STATUS: Non-Exempt · JOB SUMMARY: · The Payment Posting Specialist is accountable for ensuring that all deposits are uploaded to the billing system daily; Electro ...
-
Talent Acquisition
3 weeks ago
Health Insurance Alliance Miami, United StatesJob Description · Job DescriptionSalary: 55,000- 65,000 · Status: Remote, Full Time · Location: Florida (HQ is located in Fort Lauderdale, FL) · Dress code: Business Casual, Casual Fridays · Company: Fuego Leads and Allied Service Group · About Us · Hi, my name is Jade, Head of T ...
-
Clinical Engineer Equipment Specialist
2 weeks ago
Miami Children's Miami, United StatesJob Summary · Responsible for providing medical equipment technical support to staff, patients, and administrators relating to Nicklaus Children's Health System's wide life cycle management of medical equipment and systems. Performs routine tasks involved in the installation, mai ...
-
Supply Chain Specialist
1 week ago
NativePath Miami, United StatesJob Description · Job DescriptionSupply Chain Specialist · NativePath is looking for a Supply Chain Specialist to join our team. This combined role will provide purchasing support and promote daily purchasing guidelines and best practices for the department. The Specialist will ...
Revenue Cycle Specialist - Miami, United States - Alivi
Description
Job Description
Job DescriptionSUMMARYThe primary responsibility of this position is to identify and analyze circumstances that result in an open claim status. This involves coordinating tasks to guarantee that both external and internal deadlines are adhered to, facilitating the prompt processing and resolution of open claims. The objective is to conclusively settle all claims within the designated timely submission period. This encompasses but is not limited to, overseeing the coordination of billing procedures and conveying identified trends and patterns to relevant stakeholders while accurately applying contractual obligations and service level agreements during the execution of billing operations.DUTIES & RESPONSIBILITIESPowered by JazzHR
7fOpmrQmU6
Revenue Cycle Specialist professionals in Miami
-
Luis Rosales
Marketing Executive | Product Management
-
Jasmine Walton
Sales
-
Diogenes Camilo
Account Executive