Revenue Cycle Specialist 3 - Legal Billing (H)

Revenue Cycle Specialist 3 - Legal Billing

The Revenue Cycle Specialist 3 - Legal Billing provides advanced support in the Compromised Settlements Unit, manages complex cases, subpoenas, statutory attorney requests, patient accounts, billing, and Epic Workqueues (WQs), and resolves highly complex account and claim issues under the direction of the Unit Supervisor.

Core Responsibilities:

• Serves as the lead liaison for law firms, third-party records retrieval companies, patient advocates, and internal departments for complex Personal Injury (PI), Workers' Compensation (WC), bankruptcy, probate, and billing dispute accounts to ensure all actions comply with HIPAA and applicable Florida statutes.
• Files claims with the clerk of court for probate matters and assists with objections to claims, ensures accuracy and compliance with procedural requirements.
• Processes complex subpoenas and statutory attorney requests independently for billing records, and handles billing disputes and other legal or statutory requests to ensure HIPAA compliance, accuracy, and completeness of all documentation.
• Handles sensitive patient advocate inquiries and resolves escalated account issues in accordance with hospital policies and consumer protection regulations.
• Bills appropriate payers accurately and in a timely manner, ensuring compliance with Florida prompt pay laws.
• Communicates proactively via email, fax, and phone with law firms, patient advocates, and internal departments to resolve complex account and claim issues while maintaining statutory compliance.
• Applies billing indicators, holds, and adjustments per organizational policies and EOBs.
• Reviews, interprets, and applies EOB information to resolve complex billing and insurance claim issues, providing guidance and oversight to staff.
• Negotiates settlements in accordance with organizational policy and Fair Debt Collection Practices Act (FDCPA) and Florida Consumer Collection Practices Act (FCCPA) guidelines.
• Monitors, manages, and optimizes Epic WQs, ensuring timely follow-up, accurate rebilling, resolution of claims, and compliance with internal deadlines.
• Mentors, trains, and guides lower-level staff on procedures, workflows, best practices, EOB interpretation, compliance requirements, and contract/vendor processes.
• Assists peers in troubleshooting complicated accounts or disputes.
• Identifies trends or recurring issues and recommends process improvements, workflow efficiencies, and best practices to maintain compliance and operational excellence.
• Interprets and applies internal contracts, vendor agreements, and bad debt policies to ensure compliance, accurate billing, and proper resolution of complex accounts.
• Stays current on updates to HIPAA, Florida statutes, prompt pay laws, and organizational policies, sharing guidance with team members.
• Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Core Qualifications:

• High School Diploma or equivalent/relevant experience, certification or license
• Minimum 5 year of relevant experience required

Knowledge, Skills and Abilities:

• Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands.
• Teamwork: Ability to work collaboratively with others and contribute to a team environment.
• Technical Proficiency: Skilled in using office software, technology, and relevant computer applications.
• Communication: Strong and clear written and verbal communication skills for interacting with colleagues and stakeholders.

Any relevant education, certifications and/or work experience may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.