Fiscal Assistant II

1 week ago

Fort Lauderdale, United States The State of Florida Full time $21

DUTIES

Claims Denial, Appeals, and Collections
  • Accurately audit the medical EOBs (Explanation of Benefits) for inappropriate reimbursement, denied, delayed, or partially paid claims.
  • Corroborate reversal of the insurance plan determination through the claim's appeals process according to the insurance plan's provider handbook.
  • Maintain an insurance follow-up log of claims appeals.
  • Run accounts receivable report in HMS (Health Management System) by insurance company to keep track of the claims aging process.
  • Follow-up in writing or by phone call with insurance plans to assure collections of incorrectly denied or partially paid claim.
  • Accurately post and document in HMS the denied claims and partial payments.
  • At last resort, file a complaint in the AHCA's (Agency for Health Care Administration) complaint hub only with the written approval from your supervisor.
Billing Responsibilities
  • Responsible for the accuracy and timeliness of medical billing to all insurance companies.
  • Capture the correct charge for every service provided.
  • Prevent denials of claims.
  • Perform all necessary tasks in HMS billing portal to ensure appropriate reimbursement.
  • Sample tasks in HMS include recording services, marking & billing services, maintaining service descriptions, creating and fixing bill files, importing electronic billing records, printing and sending hardcopies of CMS1500 and ADA forms to insurance companies.
Claims and Billing Audit and Quality Assurance
  • Responsible for daily audit and quality assurance of all dental and medical claims for all clinics at Broward County Health Department.
  • Audit all encounters for dental & medical services to ensure appropriate and correct billing.
  • Review service encounters against the electronic health record, ensure appropriate coding, and verify payor sources.
  • Correct errors in HMS and train clinic staff making errors.
Payment Posting
  • Post all Explanation of Benefits (EOB) from insurance companies in HMS.
  • Ensure correct reimbursement amounts are posted.
  • Sample tasks include creating vouchers, posting payments, and reconciling vouchers.
Assist in Training of Data Entry Process
  • Assist in training new employees in data entry processes.
  • Provide training in FMMIS and HMS basics.

MINIMUM QUALIFICATIONS

  • Willingness to work outside normal hours in emergencies.
  • Data entry experience.
  • Experience conducting medical/dental insurance eligibility.
  • One year of customer service experience in a clerical/cashier position.

PREFERRED QUALIFICATIONS

  • Two years of health insurance claims processing experience.
  • Associate's degree or higher in finance, accounting, or business administration.
  • Current certification as a Certified Professional Coder (CPC).

Benefits of Working for the State of Florida

  • State of Florida 401(a) FICA Alternative Plan.
  • Participation in state group insurance (upon eligibility).
  • Workers’ Compensation and Reemployment Assistance.
  • Deferred Compensation and Employee Assistance Program (voluntary).

Please visit www.mybenefits.myflorida.com for more information on benefits.

This position may require a security background check, drug screening, and participation in direct deposit.

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