At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.

Summary

Position Highlights:

The Reimbursement Recovery Specialist is responsible for securing the payment of medical claims in a timely and efficient manner in order to secure the financial health of H. Lee Moffitt Cancer Center. This includes analyzing, identifying and resolving barriers, monitoring unpaid claims, analyzing denied, pended or underpaid claims, appealing administrative denials, resolving administrative and clinically appealed claims and, when applicable, reviewing credit balances and payer payments for the Accounts Receivable Team. The specialist reviews all payer refund requests for appropriateness and appeals/contests when applicable. This position protects and defends contract terms, Letters of Agreement and Rate Agreements.

 

ESSENTIAL FUNCTIONS:

 

Collection Follow-up:

Takes steps to secure payment on aged receivables by making outbound calls, utilizes payer portals, payer website or 277 Transmission Code Sets for account status. Takes appropriate action, when necessary, including submitting required documents, i.e., itemization of charges, medical records, on claims pended for payment. Appeals all administrative denials, submits Reconciliation forms, etc., on denied claims. Analyze denied or partially paid claims and determine steps to achieve appropriate reimbursement.

Worklists:

Works all Worklists (WLs) throughout each day, every day. Demonstrates proper sorting of WLs. Responds to written correspondence received from payer and/or patients. Reviews payer refund requests, contesting and/or appealing those that are not appropriate. Is responsible to stay current on all active, assigned accounts which prevents abandonment, uncollected account receivables. Ensures Transfer List is current and up-to-date with accounts being worked a minimum of every 30 days until resolved. Ensures follow-up and follow through are met consistently, per protocol, on outstanding accounts and escalated when applicable. Ensures collection and documentation are correct and appropriate action, if any, taken place a documented. Ensures universal abbreviates and appropriate terms are used and not lengthy, yet to the point. Reviews contracts to determine if payments are appropriate; defends contract terms, Letters of Agreement and Rate Agreements. For BMT Collectors, promptly reviews credit balances from the AR Team for possible adjustment or refund.

Productivity and Quality Audits

Meets or exceeds established productivity goals; notifies Supervisor, when necessary, of issues preventing achievement of such goal(s) per departmental Operational Guidelines. Demonstrates proactiveness when not meeting Mid-Month Productivity Goals Based on Hour Worked or Monthly Productivity Goals Based on Hours Worked by reaching out for re-education/game plan to get back on track.

Minimum Requirement:

Experience:

Minimum of three (3) years recent medical collections experience in a hospital or large group practice setting. For a large group setting, primary responsibility is that of insurance collections and follow-up and/or Denials Management.

Preferred:

For the Commercial and Aetna/Blue Cross/United Teams, experience with commercial payors preferred, including eligibility inquiries and Denials Management. Billing and claim submission experience, preferably on a UB04, is a plus. For the Medicare and Medicaid Team, experience with Medicare, Medicare Advantage and Medicaid preferred, including eligibility inquiries via DDE or SPOT and Denials Management. Billing and claim submission experience, preferably on a UB04, is a plus.

 

Education

High School Diploma/GED

Preferred:

Associate’s Degree within Healthcare Administration, Accounting, Business, Finance or other relevant discipline