AdventHealth

Medical Director

• Provide primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments
• Serve as a liaison between UM and CM teams and medical staff and act as medical liaison for payor escalations
• Educate, inform and advise Utilization Management, Care Management, Managed Care and Revenue Cycle departments and applicable medical staff
• Collaborate with other disciplines to improve clinical documentation, patient safety, and quality outcomes
• Provide clinical review of utilization, claims management, and quality assurance for inpatient care, outpatient/observation stays and referral services
• Serve as a contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies
• Act as subject matter expert providing clinical expertise and business direction for medical management programs to promote high-quality, patient-focused, cost-effective care
• Develop relationships with physicians and stakeholders, provide education, clarify clinical questions, and support ACO activities and program development

Medical Director, Physician Advisor – UM

• Provides primary support for Utilization Management (UM) and secondary support for Care Management (CM)
• Serves as a liaison between UM and CM teams and medical staff and as medical liaison for payor escalations
• Educates, informs and advises Utilization Management, Care Management, Managed Care and Revenue Cycle departments and medical staff
• Collaborates with other disciplines to improve clinical documentation, patient safety, and quality outcomes
• Provides clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient/observation stays and referral services
• Acts as contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies
• Serves as subject matter expert providing clinical expertise and business direction for medical management programs to promote high-quality, patient-focused, cost-effective care

Medical Director – Physician Advisor, Utilization Management

Accountant

• Facilitating the reconciliation of cash for various entities.
• Handles upfront reconciliation, payment posting, backend reconciliation, and posting corrections.
• Posts journal entries related to these functions.
• Ensures accuracy and compliance in financial records.
• Analyzes and verifies financial records to ensure accuracy and compliance.
• Identifies discrepancies and resolves issues in financial transactions.
• Matches and reconciles bank statements with internal records.
• Assists with audits by providing necessary documentation and explanations.
• Develops and implements process improvements to enhance reconciliation efficiency.
• Provides regular reports on reconciliation status and issues to management.
• Maintains detailed documentation of reconciliation processes and findings.
• Ensures timely and accurate posting of payments and corrections.
• Investigates and resolves variances in account balances.
• Collaborates with other departments to gather necessary information for reconciliations.
• Reviews and reconciles accounts payable and receivable.
• Prepares and posts journal entries related to reconciliations.

Special Projects Accountant

Account Manager

• Responsible for billing, follow-up, and managing denials to timely collect on assigned accounts receivable.
• This position communicates daily with team members and managers to meet prescribed deadlines.
• This role examines contracts and learns payer contracts to understand reimbursement methodology and appropriately reconcile patient accounts.
• This position resolves and resubmits rejected claims, processes daily and special reports, and reviews previous account documentation to determine necessary actions.
• Additionally, this role performs outgoing and incoming calls with patients and insurance companies to obtain information for accurate billing and collections.
• Works with insurance payers to ensure proper billing, collections, or denial management on patient accounts.
• Examines contracts to ensure proper reimbursement, educates team members on inconsistencies, and documents any changes.
• Works follow-up reports daily, maintaining established goals, and notifies the supervisor of issues preventing goal achievement.
• Follows up on daily correspondence related to denials, underpayments, and billing to appropriately manage patient accounts.
• Assists customer service with patient concerns and questions to ensure prompt and accurate resolution.
• Produces written correspondence to payors and patients regarding claim status and requests for additional information.
• Reviews previous account documentation to determine necessary actions to resolve assigned accounts.
• Initiates next billing, follow-up, and collection steps, including contacting patients, insurers, or employers as appropriate.
• Documents billing, denials, and collection steps taken, escalating to the supervisor or manager if necessary.
• Processes administrative and medical appeals, refunds, reinstatements, and rejections of insurance claims.
• Communicates consistently with team members to foster a collaborative atmosphere and engages with the supervisor or manager on educational opportunities.
• Assists with training new staff, performs audits of work, and communicates progress to the appropriate supervisor.
• Other duties as assigned.

Account Representative II, Billing/Collection/Denials

Account Representative II – Billing, Collections, Denials

• Responsible for billing, follow-up, and managing denials to timely collect on assigned accounts receivable.
• Communicates daily with team members and managers to meet prescribed deadlines.
• Examines contracts and learns payer contracts to understand reimbursement methodology and appropriately reconcile patient accounts.
• Resolves and resubmits rejected claims, processes daily and special reports, and reviews previous account documentation to determine necessary actions.
• Performs outgoing and incoming calls with patients and insurance companies to obtain information for accurate billing and collections.
• Works with insurance payers to ensure proper billing, collections, or denial management on patient accounts.
• Examines contracts to ensure proper reimbursement, educates team members on inconsistencies, and documents any changes.
• Works follow-up reports daily, maintaining established goals, and notifies the supervisor of issues preventing goal achievement.
• Follows up on daily correspondence related to denials, underpayments, and billing to appropriately manage patient accounts.
• Assists customer service with patient concerns and questions to ensure prompt and accurate resolution.
• Produces written correspondence to payors and patients regarding claim status and requests for additional information.
• Reviews previous account documentation to determine necessary actions to resolve assigned accounts.
• Initiates next billing, follow-up, and collection steps, including contacting patients, insurers, or employers as appropriate.
• Documents billing, denials, and collection steps taken, escalating to the supervisor or manager if necessary.
• Processes administrative and medical appeals, refunds, reinstatements, and rejections of insurance claims.
• Communicates consistently with team members to foster a collaborative atmosphere and engages with the supervisor or manager on educational opportunities.
• Assists with training new staff, performs audits of work, and communicates progress to the appropriate supervisor.
• Other duties as assigned.

Account Representative II – Billing/Collections/Denials

· Provides primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments and serves as a liaison between UM and CM teams and medical staff, as well as, the medical liaison for payor escalations.
· Responsible for educating, informing and advising members of UM, CM, Managed Care and Revenue Cycle departments and applicable medical staff, collaborating with other disciplines to improve clinical documentation, patient safety, and quality outcomes.
· Provides clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services.
· Acts as important contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies; subject matter expert providing clinical expertise and business direction in support of medical management programs.

Medical Director / Physician Advisor – UM

• The role you will contribute: Under general supervision and direction, it's the responsibility of the Account Representative II to bill, follow-up, and manage denials to timely collect on assigned accounts receivable.
• Daily communicates with team members and manager on assigned projects in collaboration to meet prescribed deadlines.
• Examines contracts, and learns payer contracts to understand reimbursement methodology to appropriately reconcile patient accounts.
• Resolves and resubmits rejected claims appropriately as necessary.
• Processes daily and special reports, unlisted invoices and letters, error logs, stalled reports, and aging claim reports.
• Reviews previous account documentation, determining appropriate action(s) necessary to resolve avoid denial, and facilitate timely payment.
• Performs outgoing calls and accepts incoming calls from patients and insurance companies to obtain necessary information for accurate billing, collections, and correction of denials, accurately documenting the patient account.
• Actively prioritizes all outstanding customer service concerns and accepts responsibility in maintaining relationships that are equally respectful to all.
• Participates in continuing education, team meetings, and performs other functions as assigned by supervisor/manager.
• Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies.
• Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
• The value you will bring to the team: Works with insurance payers to ensure proper billing, collections, or denial management on patient accounts.
• Depending on payer contract may be required to participate in conference calls, review accounts receivable reports, and compile the issue report to expedite resolution of accounts.
• Examines contract to ensure proper reimbursement, helps educate team members on inconsistencies in processing, and document any changes contract, if identified.
• Works follow up report daily, maintaining established goal(s), and notifies supervisor of issues preventing achievement of such goal(s).
• Follows up on daily correspondence (denials, underpayments, billing) to appropriately work patient accounts.
• Assists customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved.
• Produces written correspondence to payors and patients regarding status of claim, requesting additional information, etc.
• Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account.
• Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate.
• Sends initial or secondary bills to Insurance companies Documents billing, denials and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to supervisor/manager if necessary.
• Processes administrative and medical appeals, refunds, reinstatements, and rejections of insurance claims.
• Consistently communications with team members to foster a collaborative atmosphere and engages with supervisor/manager on any potential educational opportunities, providing updates on assigned projects.
• Attends required scheduled meetings, events, and activities
• Assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by manager.
• Helps with training new staff, performs audits of work performed, and communicates progress to appropriate supervisor.
• Assist the supervisor/manager as requested.
• Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account
• Takes on department projects as assigned by their supervisor and/or manager

Account Representative II - Billing/Collections/Denials

Program Manager

• Under General Supervision, The Radiology Safety and Quality Program Manager is responsible to ensure consistent product and service quality and safety throughout AHMG – Radiology, system-wide.
• This involves knowledge of radiological procedures and radiographic equipment.
• Responsible for compliance with organizational/departmental and regulatory standards by conducting rounding and performing audits.
• Participates in the development of corrective action plans as necessary utilizing the PDSA performance improvement process.
• Collects and provides data for analysis and process improvement.
• Oversees and coordinates the maintenance of radiology practice policies and SOP's.
• Oversees, maintains, and processes records / inspections to meet State/ Federal/ DNV and ISO 9001/ Organizational guidelines. Adheres to HIPAA compliance. Ensures that Imaging Policies and SOP’s are maintained within the Imaging service line through review and development. Regulatory Compliance
• Ensures consistent safety and quality in image production by assisting with troubleshooting and overseeing the process of addressing errors.
• Image Quality and Documentation
• Develops spreadsheets and electronic directory(s) to better manage information and facilitate access to fellow staff.
• Maintains proficiency with PACS, RIS and mainframe systems to best conduct/monitor QC evaluation.
• Prepares quality data reports by collecting, analyzing and summarizing information and sharing trends. Submits data to the PSOrg as necessary.
• Data Processing
• Consistently attends department meetings and promotes positive dialogue with respect to meeting or exceeding department objectives.
• Communicates agenda items from Hospital committees to Imaging Service managers.
• Routinely travels to campus locations to perform surveillance audits identifying gaps and risk in process and procedures.
• Supports campus leaders in meeting quality and safety expectations by providing feedback and identifying opportunities for improvements.
• Personal Productivity and Accountability
• Represents Imaging Services Department on issues of EPA, FDA, ACHA, CMS, DNV and other regulatory bodies. Represents Imaging in disaster preparedness. Adheres to Infection Control practices. Safety & Environment of Care