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Revenue Cycle Specialist Full Time Day in Ormond Beach, FL at Adventist Health System

Date Posted: 12/6/2018

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
  • Travel
  • Shift
    1 - Day
  • AHS Zone
    1-Shared Services
  • Organization
    FH Memorial Medical Center

Job Description

Work Hours/Shifts
Full Time, Days

Florida Hospital Memorial Medical Center    

     Our goal at Florida Hospital Memorial Medical Center is simple: to offer our patients the absolute best care around, in the most compassionate, community-focused setting possible.

     Florida Hospital Memorial Medical Center consists of two campuses: a 277-bed main hospital in Daytona Beach and a 119-bed hospital in Ormond Beach, as well as our new outpatient facility, located at the Pavilion at Port Orange. Through our Christian mission of hope, health and healing, we strive to promote wellness of mind, body and spirit. We are a recipient of the 2012 Governor’s Sterling Award, which is the highest award an organization in Florida can receive for performance excellence.

     More than 400 physicians hold privileges to practice at our facilities, and we employ more than 1,700 care-team members. Our specialties include cardiology, cancer, emergency care, surgical services, obstetrics, neurosurgery, stroke care, rehabilitation, weight-loss surgery, imaging, laboratory, home health, wound care, diabetes, hospice, physician practices and women’s services.

     Patients and families from across the country appreciate Florida Hospital Memorial Medical Center’s unique culture. Our cutting-edge technology is accompanied by the holistic environment and patient-centered care that have defined Florida Hospital for more than a century. Best of all, it’s just a short trip from some of Florida’s most exciting attractions—and minutes from the Sunshine State’s premier beaches.

  • Responsible for performing and processing accurate billing procedures for all payors, electronically through SSI (a medical claims management system that assists Florida Hospital Patient Financial services (FH PFS) insurance reimbursement team with claims editing and validation). Works independently, meeting time and daily deadlines in an accurate and efficient manner, communicating any issues to leadership.
  • Ensures expeditious and accurate insurance reimbursement for all Government and Managed Care payors. Updates a high volume of daily claims appropriately in SSI system. Appropriately determines, initiates, and follows through on the status of claims in SSI, such as place on hold, delete, or assigns account error to responsible, supporting department. Documents billing, follow-up and/or collections step(s) that are taken as well as the result and next step needed to resolve the assigned payment
  • Monitors and audits status of errors assigned to other areas or PFS teams for all payors daily, ensuring timely follow up and expeditious billing. Communicates with key management staff and supporting department partners effectively and professionally, to ensure key metrics are being addressed timely. Assist in identifying key trends as applicable or opportunities for improvement.
  • Maintains communication between external or contracted agencies, business vendors and partners, FH department (i.e. Revenue Management, Laboratory, Contract Management, Case Management, Payors, etc.…) ensuring compliance between external relationships, knowledge of contractual terms, and performance protocols. Informs leadership of any foreseeable issues with partners. Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved.
  • Processes and records agency audit notifications and responds in designated timeframe to ensure compliance with government and/or contractual requirements for timely response.
  • Works all assigned insurance payers to ensure proper reimbursement on patient accounts to expedite resolution. Processes medical, administrative, technical appeals, request refunds when applicable, and rejections of insurance claims.  Ensures proper escalation is met when account receivable is not collected in a timely manner.
  • Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues. Responds to written correspondence received from Payer and/or Patients.  Is responsible to stay current on all active, assigned accounts which prevents abandonment, uncollected account receivables.
  • Assists Customer Service area with patient concerns/questions to ensure prompt and accurate resolution is achieved. Ensures we foster a team-spirited approach while interacting with co-workers, peers, management, etc.  Stays committed to delivering superior customer service to our patients.
  • Analyzes previous account documentation, to determine appropriate action(s) necessary to resolve each assigned account.   Initiates next billing, follow-up and/or collection step(s), not limited to calling Patients, Insurers or Employers, as appropriate.  Remits initial or secondary bills to insurance companies immediately following payment from the primary insurance payer.
  • Coordinates with multiple departments to resolve denials and payment discrepancies including but not limited to Case Management, Billing, Coding, and Refunds departments.
  • Key members of the Revenue Cycle team will also be responsible for, daily, certain specific functions.
    • Monitoring for and processing 24 and 72 hour overlapping accounts.
    • Monitoring and processing status changes.
  • Applies appropriate adjustments to accounts because of the audit. Analyzes previous account documentation to determine the appropriate write off code of medically denied charges for the right reason.
  • Reviews follow-up codes submitted to other departments daily for appealed claims and communicates with departments to ensure timely response.
  • Performs comprehensive and accurate follow-up on each account to ensure prompt resolution is achieved in a timely manner. Documents steps taken as well as the result and next step needed to resolve the assigned payment.
  • Maintains accurate and comprehensive records of each phase of appeal. Works appeal denials daily to ensure accounts are processed to next appeal level in a timely manner or determination is made for acceptance of denial.
  • Facilitates appeals on assigned accounts when appropriate and as specified in payor contract to receive payment for denied services.
  • Monitors accounts for incorrect insurance address/information and follows up on accounts that have been billed to payors to review for timely payment or denial. Re-classes daily and resubmits corrected claim as appropriate. 
  •  Computer/data entry skills required. Proficiency in performance of basic math functions. Communicates professionally and effectively, both verbally and in writing 


  • High School diploma or GED required. 
  • One-year experience in healthcare, finance, accounting, banking, insurance, or related fields.
  • One year of college can be substituted for experience.
  • One-year experience in healthcare claims processing or collections PREFERRED.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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