Address
Form of workLocation: Tallahassee, FL
Regular/Temporary: Regular
Full/Part Time: Full-Time
Job ID: 57473
Department
University’s Health Services (UHS) at Florida State University (FSU) envisions a healthy community where every student thrives. UHS’s mission is to promote and improve the overall health and well-being of FSU students. UHS is housed in the Mary B. Coburn Health and Wellness Center, a 170,000 square-foot multipurpose facility built in 2012. The Health and Wellness Center includes classrooms, a nursing triage clinic, a priority clinic, a fitness center, and a healing garden for personal reflection.
ResponsibilitiesPosting and Reconciling Insurance Payments:
- Accurately and timely receipts payments into EMR. Processes necessary reports to ensure funds will be linked to the appropriate account.
- Reviews and ensures third-party insurance billing service posts payments accurately into EMR. Reports errors and/or performs corrections as necessary.
- Based on insurance provider Explanation of Benefits (EOB) and Health Center procedure, creates proper adjustments to maintain accurate claim balances.
When necessary, initiate a refund to either the student's University account or the appropriate insurance provider. - Performs payment reconciliations for EFTs, virtual credit card payments and checks with EClinicalWorks with CTL.
- Ensures charges that are billed to student accounts are accurate.
Monitoring Health Insurance Claims:
- Monitors claim statuses and utilizes claim denial reports and other appropriate reports to research rejections and denials to identify trends and root causes.
- Collaborates with the third-party insurance billing service to resolve issues and push rejected claims through resubmission to revenue collection as fast as possible prioritizing the dollar value of claims.
- Review the pricing of medical partners (Quest and others) and update the price list accordingly.
- Prepares weekly and monthly revenue cycle reporting as assigned.
- Maintains Clinician Credentialing to maximize insurance billing reimbursements:
- Communicate with insurance companies (commercial and Medicaid) to timely provide documentation of licensure, Curriculum Vitae, and work histories as well as any other requested documentation to initiate and maintain UHS clinician credentialing and dispute discrepancies.
- As needed, create, and maintain CAQH profiles on all clinicians. Prepares and obtains appropriate information and signatures as needed to update NPI (National Provider Identifier) Enumerator for taxonomy code changes or corrections.
- As required, monitors and updates provider profiles in third-party claims clearinghouses. Ensures compliance with annual HEDIS (Healthcare Effectiveness Data and Information Set) attestations. Initiates and maintains provider licenses and profiles in EMR.
Supports billing customer services:
- Answers questions from patients, staff, and insurance companies regarding insurance coverage and claims status. Investigates and resolves patient and insurance billing complaints and errors. Interprets the billings of physicians, hospitals, and other providers and explains coverage issues, reimbursement procedures, and related insurance issues.
- Maintains P-card usage within University procurement guidelines to make purchases and pay invoices.
- High School diploma or equivalency and four years appropriate experience or a combination of post high school education and experience equal to four years.
- Skill in preparing clear and concise reports, policies, procedures, correspondences, and other written materials.
- Knowledge of accounting systems and practices.
- Knowledge of Health Insurance terminology, coding, payment standards, and procedures.
- Ability to maintain accurate records and retrieve files from active or archive sources.
- Ability to compile, review, and reconcile data for accuracy, completeness, and compliance.
One of the nation's elite research universities, Florida State University preserves, expands, and disseminates knowledge in the sciences, technology, arts, humanities, and professions, while embracing a philosophy of learning strongly rooted in the traditions of the liberal arts and critical thinking. Founded in 1851, Florida State University is the oldest continuous site of higher education in Florida. FSU is a community steeped in tradition that fosters research, encourages creativity, and embraces diversity. At FSU, there’s the excitement of being part of a vibrant academic and professional community, surrounded by people whose ideas are shaping tomorrow’s news!
Learn more about our university and campuses.
Salary will be commensurate with experience and may include a comprehensive benefit package i.e.; health insurance, life insurance, dental insurance, vision insurance, short and long term disability insurance, health and dependent care savings accounts, retirement, and professional development funds.
FSU Total RewardsFSU offers a robust Total Rewards package. Visit our website to learn more about our Compensation, Benefits, Wellness, Recognition, and Employee Development programs.
Use our interactive tool to calculate Total Compensation options based on potential salary, benefits and retirement contributions, earned leave, and other employment-related perks.
If qualified and interested in a specific job opening as advertised, apply to Florida State University at https://jobs.fsu.edu. If you are a current FSU employee, apply via myFSU > Self Service.
Applicants are required to complete the online application with all applicable information. Applications must include all work history up to ten years, and education details even if attaching a resume.
Certain service members and veterans, and the spouses and family members of such service members and veterans, receive preference and priority, and certain service members may be eligible to receive waivers for post secondary educational requirements, in employment by the state and its political subdivisions and are encouraged to apply for the positions being filled. Veterans' Preference applies to University Support Personnel System (USPS) positions only.
IMPORTANT: To claim Veterans' Preference, select “yes” to the question on the application questionnaire and upload a DD-214 (or equivalent), the Veterans' Preference Certification form, and other documentation if applicable with your online application before midnight of the position closing date.
Click the links for eligibility information and required documentation, or call FSU Human Resources at (850) 644-6034.
ConsiderationsThis is an USPS (University Support Personnel System) position.
This position requires successful completion of a criminal history background check.
This position requires pre-employment PPD (TB) and successful completion of post hire OSHA training.
Equal Employment OpportunityAn Equal Opportunity/Access/Affirmative Action/Pro Disabled & Veteran Employer.
FSU's Equal Opportunity Statement can be accessed at: https://hr.fsu.edu/sites/g/files/upcbnu2186/files/PDF/Publications/diversity/EEO_Statement.pdf.
