Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize, and make daily use of information. Coordinate daily workflow to coincide with payment cycle. Responsible for participating in management in the overall accounts payable functions in the organization. Reports to the Director of Accounting.

EDUCATION AND QUALIFICATIONS:

• High School diploma or GED equivalent. Associate’s degree in related field is preferred.
• Minimum of one (1) year related experience required.
• Experience in medical/insurance preferred.
• Team-centered with excellent work ethic and reliability.
• Experience with UB/institutional (CMS-UB04) and HCFA/professional (CMS-1500) claims.
• Familiarity with medical terminology, procedure and diagnosis codes preferred.
• Ability to calculate figures and co-insurance amounts.

ESSENTIAL JOB RESPONSIBILITIES:

• Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services.
• Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations.
• Review different payors to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines.
• Support accounts payable activities for accurate and timely processing.
• Complete coding and record accounts payable entries.
• Process refunds, appeals, disputes, and adjustments (when applicable).
• Participate in accounts payable processes.
• Identify process improvement opportunities and recommend enhancements.
• Handles any additional responsibility as assigned.

EEO Statement:

Gulfside Healthcare Services, Inc. is committed to Equal Employment Opportunity (“EEO”) and complies with all federal, state, and local laws that prohibit workplace discrimination and unlawful retaliation.

NOTE: All Gulfside Healthcare Services positions (except some Thrift Shoppe Positions) require an AHCA Level 2 Fingerprint screening for eligibility through the AHCA Florida Care Provider Background Screening Clearinghouse.  Please refer to this link for more information on this:  https://info.flclearinghouse.com