UF Health

Overview

Summary:

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.

Responsibilities

Competencies:

Hospitality:

• This domain incorporates the company value, "Caring."
• Employees are exhibiting hospitality when they are acting as hosts and are creating a welcoming, warm, and safe environment for patients, visitors, customers, and co- workers.
• Standards of Behavior in this domain include: First Impressions, Etiquette in Shared Spaces, Way-Finding, Patient & Customer Interaction, AIDET Communication, Patient Wait Times, Noise Levels, Patient & Visitor Problem-Solving.

Communication:

• Recognizes the need to make the exchange of critical information in a warm, welcoming and attentive manner. Make a personal connection that leads to excellent patient care and a positive experience for all customers.
• Practices all applicable items on the Hospitality Checklist at https://bridge.ufhealthorg/hospitality/resources/
• Achieves: Respects the patient's rights to privacy and confidentiality. Does not discuss patient care/employee information in public areas; maintains patient/employee information in a secure location. Actively listens to customers; insures customers understand both verbal and written communication. Uses appropriate body language and is hospitable in both oral and written communication.
• Exceeds: Is a role model in exhibiting all aspects of the communication standards on the hospitality checklist. The employee is acknowledged frequently for observable actions in his/her communications to customers. Maintains composure and provides compassion and empathy even when faced with hostility from others and/or other stressful conditions and anticipates customers' need for follow-up communication.

Teamwork:

• Works cooperatively with co-workers, volunteers, medical staff and other team members to achieve goals.
• Practices all applicable items on the Hospitality Checklist at https://bridge.ufhealth.org/hospitality/resources/
• Achieves: Helps and supports others in their efforts to solve customer problems and accomplish UF Health's goals, including patient/customer transition to next point of contact; listens to the concerns of the team, and communicates appropriately; shares information and own expertise with others to help others accomplish group goals; gives credit and recognition to others who have contributed to the team; supports and acts in accordance with final group decisions even when such decisions may not entirely reflect one's own position. Maintains respectful interactions with team members and treats colleagues with courtesy and respect. Recognizes coworker's accomplishments and acknowledges their successes on behalf of the team. Manage-up co-workers' contributions to the team.
• Exceeds: Helps to keep levels of team performance and morale high even during periods of intense pressure and high work volume; looks for alternative ways to work with others that will create better results and working relationships; solicits a diversity of perspectives on issues and uses ideas contributed by team members to shape decisions; breaks down barriers or organizational boundaries to ensure team's success. Is seen by co-workers as a role model in improving the appearance of the immediate work site as well as improving the appearance of the facilities outside of the immediate work site.

Professionalism/Responsibility:

• This domain incorporates the company values, "Integrity," "Quality," and "Accountability."
• Employees are exhibiting professionalism and responsibility when they act as ambassadors of UF Health and ensure that their integrity, appearance, work environment, and quality of work improve patient and customer perceptions, and UF Health's reputation.
• Standards of Behavior in this domain include Personal Responsibility, Physical Appearance & Presentation, and Appearance & Maintenance of Work Areas.

Responsibilities:

• Analyze invoices in Epic follow-up work queues 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 work queues daily to ensure research coordinators are reviewing unbilled charges timely. Monitor follow up-work queues to resolve unpaid claims. Resolve billing errors on posted charges and make corrections as needed on charges in charge review work queues.
• 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.

Qualifications

Experience Requirements: 3 years-Medical billing/claims experience including coding, medical terminology, and third-party reimbursement

Preferred Experience - 1: Up to 1 year-Computer experience in medical billing

Required Experience - 2: Up to 1 year-Managed Care Administration or Payer experience or claims processing experience

Preferred Experience - 3: 1 year-Epic system experience