Job Description

Job Objective :

Under the direction of the Vice President of Revenue Cycle or designee , the E xplanation of Benefits (EOB) R eviewer ensures all that all Commercial and Managed Care payments and adjustments are posted correctly, and that the balance is moved to the next payor or underpayment bucket accurately and timely .

Duties and Responsibilities :

• Verify that all payments and adjustments are posted to correct insurance plan.
• Verify that payment s are paid per the terms of the contract and adjust balances , as needed.
• Assign and forward all under-paid accounts to the Appeals Department
• Move balance s and / or queue secondary clai ms, as needed.
• Move remaining balance to self-pay , as appropriate .
• Assist with posting zero payment EOBs, as needed .
• Ensure if Insurance over paid that it is assigned to the pending Insurance refund agency.
• Pull supporting documents for annual regulatory audits, as needed.
• Other duties as assigned, within skillsets and abilities.

Knowledge

• Working knowledge of HMO, PPO, and Commercial reimbursement
• Working knowledge of Managed Care contract language and interpretation
• Technical knowledge of all reimbursement methodolog ies, APC, DRG, Per Diem, etc.

Abilit ies

• Strong analytical and math skills .
• Ability to work in a fast-paced team environment , as well as independently.
• Ability to remain professional and courteous at all times , rega rdless of the situation.

Education

High School graduate or equivalent

Experience

• Minimum 1- year previous C ommercial, HMO and PPO insurance follow-up experience
• Previous EOB Reviewer experience, preferred.

What Should I Know About Hialeah Hospital?

Our 378-bed acute care hospital opened in 1951 to serve the Hialeah, Florida community. Our team is committed to honoring the trust that our patients place in us by providing compassionate, safe, high-quality care in the right place, and at the right time.

Hialeah Hospital has been honored to receive a number of awards and designations for our superior health care services, including:

Cardiac

American Heart Association Get with the Guidelines - Heart Failure Gold Plus Award, 2018

American Heart Association Get with the Guidelines - Target Stroke Gold Plus Award, 2018

Bariatric

American College of Surgeons/American Society for Metabolic and Bariatric Surgery - MBSAQIP Accredited Center

BCBS - Blue Distinction Specialty Care Bariatric Surgery, January 2018

Neurology

Advanced Primary Stroke Center Re-accreditation, April 2018

Women's Services

American College of Radiology granted Stereotactic Breast Biopsy Re-accreditation, March 2016

Hyperbaric Unit

Healogics Center of Distinction Award, 2017

Laboratory Services/Blood Bank

Certificate of Accreditation from College of American Pathologist

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