Contract Review & Insurance Reimbursement Specialist

University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family. The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians’ practice at hospitals and medical offices throughout the region.

University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.

POSITION SUMMARY

Performs job duties in accordance to established procedures, policies and detailed instructions, drive resolution and promote peak performance while delivering world class revenue cycle outcomes. This position interacts daily with team members, insurance representatives and other departments in an effort to quickly resolve outstanding account balances while enhancing the patient experience and promoting code of conduct to ensure integrity and compliance.

ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES

1. Maintains library of contracts and amendments to serve as complete records. This includes original contracts and dates of all amendments to those contracts.
2. Fee schedule building: must be able to apply percentages to applicable CMS rates and base fee schedule rate information contained within the payer contract. This includes updating physician fees as the CMS and base fee schedule rates change. Must be able to predict accurate reimbursement rates for DME equipment as well as understanding wholesale ASP rates based on quarterly updates.
3. Maintaining proprietary fee schedules: must maintain accurate reimbursement rates based on any given date of service for which UTP submits charges. This includes applying percentage increases to physician base rate fee schedule if uplifts or incentives are a part of the contract language or when we are notified of a rate change.
4. Will use the under payment/under billing features in Epic system to report potential loss of revenue to Revenue Cycle Management as a result of discrepancies in either charges or reimbursement.
5. Routinely monitors reimbursement and opens communication with payer to rectify and collect any deviation in the contracted rate vs reimbursement rate. Monitors receipt of recovery to ensure University Toledo Physician receives the correct reimbursement for services once a discrepancy is discovered.
6. Recognizes and researches problematic trends regarding reimbursement discrepancies in an effort to increase velocity of cash collections.
7. Maintains the confidentiality of all patient records and accounts.
8. Actively participates in staff meetings and process improvement planning sessions.
9. Maintains work area in a clean and orderly fashion making sure all source documents are stored electronically on the shared network.
10. Understands HIPAA policies and procedures and uses this knowledge to practice in a manner that maintains the confidentiality of protected health information (PHI) in compliance with HIPAA.
11. Performs other duties as assigned.

REQUIRED QUALIFICATIONS

• Education: High school diploma or equivalent

• Skills:
  1. A basic understanding of insurance contracts and fee schedule information.
  2. Familiarity of medical terminology.
  3. Work requires advanced reading, writing and oral communication skills as well as the knowledge to perform mathematical calculations.
  4. Work requires interpersonal skills necessary for making patient and third-party payer contacts. Must be able to work with interruption by co-workers or other internal customers needing assistance with patient accounts.
  5. The job requires analytical and critical thinking ability to diagnose account issues and active listening skills to provide service excellence. In addition, the work requires demonstrated project and time management skills and an ability to work effectively over the phone and in a team environment.
  6. Demonstrate proficiency with computers and data entry.

• Years of Experience: 2 years of experience in medical billing.

PREFERRED QUALIFICATIONS

• Skills:
  1. Knowledge of CPT and ICD-9 Terminology.
  2. Experience with billing software.

Years of Experience: 2+ years of experience in medical billing/insurance follow up.

WORKING CONDITIONS

Works in an open office environment; area is well ventilated, lighted, and close to equipment and materials required for daily work functioning. Work requires travel to several different UTP department and practice site locations.

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace