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Certified Medical Reinbursement Specialist – Transplant - Orlando in Orlando, FL at AdventHealth

Date Posted: 2/10/2019

Job Snapshot

  • Job Schedule
  • Location:
    Orlando, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Administrative / Business Support
  • Travel
  • Shift
  • Application Zone
    2-Legacy System
  • Organization
    AdventHealth Orlando

Job Description

Billing/Credentialing Specialist – Transplant - Orlando

Florida Hospital Orlando seeks to hire a Billing/Credentialing Specialist who will embrace our mission to extend the healing ministry of Christ.

Facility Profile:

Located on a lush tropical campus, our flagship hospital, 1,368-bed Florida Hospital Orlando, serves as the major tertiary facility for much of the Southeast, the Caribbean and South America. Florida Hospital Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country. We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year.

Department Profile:

The transplant unit is the only dedicated 40-bed Kidney, Pancreas and Liver Transplant unit at Florida Hospital. Our highly trained specialty team allow us to expedite care and guide patients through the recovery process after transplant surgery. Nurses on this unit also partner closely with the Florida Hospital Transplant Institute.

Work Hours/Shifts:

Monday – Friday; 8am – 5pm

Job Summary:

Under the direction of the Assistant Director of Practice Operations, the Billing and Credentialing Specialist is responsible for a variety of complex clerical, credentialing and accounting functions for the billing of medical health providers. This position ensures that the medical billing conforms to all legal and procedural mandates. The Billing and Credentialing Specialist stays apprised of the Center for Medicare and Medicaid Services (CMS) standards and Health Common Procedure Coding System (HCPCS) revisions. This position will assist in provider credentialing for managed care. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Knowledge, Skills, Education, & Experience Required:

  • Ability to act in an autonomous, self-directed manner while maintaining the ability to collaborate with other professionals and non-professionals in situations of high complexity and high intensity
  • Knowledge of hospital and provider billing, health plan benefit limits, policies and procedures and other applicable requirements and regulations of government and non-government payers or organizations
  • Strong written and verbal communication skills
  • Ability to exercise independent judgement, initiative and decision making
  • Technical skills and aptitudes related to the insurance verification/authorization procedures or processes performed in department or work are assigned
  • Extensive understanding of CPT, HCPC, ICD-9, ICD-10 and RVU
  • Comprehensive knowledge of staff credentialing, medical reimbursement and billing procedures
  • Proficient in Microsoft Office software including Word, Excel, Power Point, and Outlook
  • Ability to learn and utilize various hospital based systems in a proficient manner
  • Bachelor’s degree in Management/Business or Healthcare related field OR
  • Five years’ experience in healthcare or related field, with specific emphasis on the billing and credentialing process.
  • One to two years’ experience in healthcare or complex practice environment, facilitating educational sessions for staff and medical health providers in the specific areas of credentialing, medical reimbursement and billing
  • Bilingual (preferred)

Licensure, Certification, or Registration Required:

  • Certified Medical Reimbursement Specialist (CMRS)
  • Certified Coding Specialist (CCS), OR (preferred)
  • Certified Professional Coder (CPCP) OR (preferred)
  • Certified Provider Credentialing Specialist (CPCS) (preferred)

Job Responsibilities:

Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization’s Performance Excellence Program

  • Independently coordinates and manages the physician credentialing and renewal application process. Assists new physicians, ARNPs, PAs, and therapists joining the practice by applying for their licenses, malpractice insurance, and hospital privileges.
  • Works collaboratively with the Assistant Director of Practice Operations on tasks related to practice billing. Acts as liaison between the assigned billing service to ensure timely and accurate billing practices are followed. Verify billable physician services are captured by review of physician and/or physician extenders documentation. Develops, evaluates, implements and tests AR System changes for maximum reimbursements.
  • Independently reviews and analyzes the billing performance indicators to include, but not limited to, preparing, reviewing and sharing reports to identify trends or patterns that present an opportunity to improve the quality of the billing process in an effort to ensure maximum reimbursement
  • Independently assesses and develops billing-related education platform for the practice. Develops billing training/education program for providers to include direct education and outsourcing of education needs. Develops associated billing policies and standard operating procedures for all payer sources.
  • Actively participates in medical review and charge audits (on-site and desktop). Serves as an expert resource and point-of-contact for audit process. Facilitates and coordinates any needs of the outside agencies for charge audits.
  • Pro-actively initiates quality improvement ideas and suggestions in an effort to improve the patient experience of care (including quality and satisfaction), improve the health of the populations served, and reduce the cost of clinic care.
  • During peak workload periods in the practice, assist and work as part of the team to ensure adequate coverage of all practice related areas.

If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Billing/ Credentialing Specialist opportunity with Florida Hospital Orlando and apply online today.

Job Keywords:

Billing/ Credentialing Specialist, Billing, Transplant, Orlando

Position Location:  Orlando
Job:  Administrative / Business Support
Organization:  AdventHealth Central Florida
Primary Location:  US-FL-Orlando
Schedule:  Full-time
Shift:  Day
Job Level:  Entry Level
Education Level:  Bachelor's Degree
Travel:  No
Job Posting:  Oct 9, 2018, 11:20:00 AM

Location | Organization | Category | Job Function