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Allowables Representative in Sunrise, FL at TeamHealth

Date Posted: 10/12/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Sunrise, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/12/2018

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

 

POSITION SUMMARY:

The Allowables Representative will review all over and under allowed claims that were not paid appropriately per contract terms. The Reps will file appeals to the carriers for the underallowed claims in order to collect the additional monies due. Communication is an integral part of this role as correcting variances is often a multi-level process; therefore, their findings must continually be shared with other departments within the Billing Center as well as Corporate Departments in order to resolve issues and to help prevent future issues.

Reporting is a major role in this position, as well as extensive review of daily, weekly and monthly corporate generated reports, and standardized reports run on a regular basis within the department. The Allowables Representative’s goal is to ensure all variances are worked appropriately, in a timely manner and to capture as much revenue as possible according to our agreements with the Insurance Carries.

ESSENTIAL RESPONSIBILITIES:

 

1.       Regular, reliable attendance and punctuality is necessary.

2.       Review/work of weekly variances reports for both over and under allowed invoices in order to monitor changes in contracted reimbursement.

3.       Review/work of Monthly Aging.

4.       Review documentation, including remittances and claims.

5.       Internet research for fee verification and product line information, participation status, telephone calls to carriers, etc.

6.       Review contract verbiage.

7.       Run standardized reports and queries.

8.       Invoice adjustments as necessary as directed by Management.

9.       Obtain updated fee schedules.

10.    Communicate openly with other departments within the Billing Center, Corporate and Affiliates in order to have identified issues resolved to eliminate variances.

11.    Collections on under allowed variances.

OTHER RESPONSIBILITIES:

 

1.     Consistently maintain weekly production reports in the time allotted.

2.     Review variances for trends. Recognize and report potential issues promptly.

3.     Attend meetings as required.

4.     Communications with Contract Management regarding fee schedule updates.

5.     Thorough understanding of the IDX system.

6.     On going training, as necessary.

7.     Complete special projects as assigned by the Allowables Manager.

8.     Follows both the Billing Center and Corporate policies and procedures.

9.     Thorough knowledge of physician billing policies and procedures.

10. Working overtime as directed by management.

11. Accepts other tasks, duties and responsibilities as assigned by management.

12. Completes all tasks accurately maintaining quality and productions standards set for the department.

13. Adheres to all HIPAA PHI Guidelines.

 

Job Requirements

POSITION REQUIREMENTS:

 

Skills

1.     Overall understanding of the entire claims process, from generation to collection.

2.     Ability to analyze trends.

3.     Excellent verbal and written communication skills.

4.     Understanding of the Managed Care contract terms.

5.     Knowledge of Microsoft office software.

6.     Knowledge of IDX software.

7.     Excellent analytical skills.

8.     Excellent organizational skills.

9.     Ability to follow through on issues to resolution as well as the ability to communicate effectively with the Billing Centers, Corporate, Affiliates and Insurance Carrier contacts.

10. Reports unresolved issues to Allowable Manager.

11. Ability to work independently, exercise judgment and maintain flexibility while maintaining the goals at hand.

12. Able to meet deadlines, maintain production.

13. Excellent attitude and the ability to work well with a many different individuals, both internal and external to the Billing Center.

 

Education

1.     Minimum of a High School diploma.

 

Experience

1.     Minimum of five years experience in multiple areas of physician billing with emphasis on collections and appeals.

2.     Knowledge of the IDX system.

3.     Excellent Excel knowledge.

4.     Understanding of Managed Care contracts.

WORKING CONDITIONS:

 

General office environment. Extensive time spent on the computer and telephone. Long periods of time sitting at a desk.