The position is available for work within the United States except from the following states: AZ,CA,CO,MD,MA,MI,NJ,NV,NM,NY,OR,RI,VT,WA, and WASHINGTON, D.C.
State locations and specifics are subject to change as our hiring requirements shift.
Work Hours: 7:00AM - 4:00PM CST / 8:00AM - 5:00PM EST Monday – Friday
**Scheduled Hours are dependent upon client needs and established schedules can be
adjusted at any time to meet the needs of the department to ensure business continuity.**
***Ideal candidate must have 1-2.5 years in denial management and insurance follow-up***
POSITION SUMMARY
The Insurance Billing & Follow-Up Representative ensures the efficient handling of all insurance billing, follow-up and collection activities. Communicates with insurance companies and state agencies. Completes reconciliation and billing of accounts making independent decisions based on payer, coding and billing guidelines. This is done by reviewing, researching, and processing claims in accordance with contracts and policies to determine the extent of liability, as well as to adjudicate claims as appropriate. The actual work performed will depend on client needs and current active projects (projects could be long-term or short-term). This position requires knowledge of the UB04, and HCFA claim billing forms, timely filing limits set forth by various payers, various payor portals for follow-up and research, and general billing policies and guidelines. This position requires the ability to work independently, meet daily productivity and quality goals, provide excellent customer service and communication skills, creativity, patience, and flexibility. The Insurance Billing & Follow-Up Representative relies on guidelines established by the organization to perform job functions and works under general supervision in a fast-paced environment.
PRIMARY RESPONSIBILITIES
- Monitor, research, and resolve no response, denied, and underpaid medical claims on Medicare and Managed Medicare, Medicaid and Managed Medicaid, Government, Commercial, MVA, Workers’ Compensation, and other Third-Party Liability payers.
- Research claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution.
- Proactively follow up on delayed payments by contacting patients and third-party payers determining the cause of delay and supplying additional data as required
- Research and resolve insurance payment recoupments and credit balances for all payer types.
- Collaborate with both internal and client departments to verify and validate billing information and coding changes.
- Partner with clients and patients to obtain additional information that aids in resolving outstanding medical claims.
- Communicate with insurance companies to effectively resolve denied and underpaid claims.
- Stay persistent in your disputes with insurance companies regarding denied claims.
- Perform accurate follow-up activities and appeal within the appropriate time frame.
- Submit or Re-Submit claims and medical documentation.
- File payer reconsiderations and/or formal appeals as needed.
- Denial root cause identification and tracking denial trends by payer, location, and service billed.
- Thorough and accurate documentation of your claim research, resolution activity, and the next step required for each account worked.
- Ability to work in multiple EMR and billing systems, adapting easily to changes in client guidelines and billing/payer systems.
- Meet daily productivity and quality performance metrics established by management.
- Strong individual work ethic with the ability to work within and positively contributes to a team environment.
- Utilize department, payer, and client resources, as well as perform independent research, to achieve completion of tasks and reduce reliance on supervisory oversight.
- Performs other duties as assigned.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
- Minimum High School diploma or equivalent required.
- Minimum 1- 2.5 years of experience in denial management and insurance follow-up is required.
- Experience in medical billing, loading and verifying insurance in the correct filing order, and medical billing customer service and collections is desirable.
- Experience working directly with EOBs, contractual adjustments, and denial remittances is required.
- A working knowledge of medical and insurance terminology is required.
- Knowledge of healthcare/insurance practices and processes.
- Knowledge of federal, state, and local laws, regulations, and rules concerning the insurance industry.
- Strong knowledge in general claim denial management and insurance follow-up protocols, processes, and best practices.
SKILLS & ABILITIES
- Prior PC, keyboard, and general computer skills is a mandatory requirement.
- Must have working knowledge in a Windows-based system: word, email, and excel would be beneficial
- Ability to compute basic math calculations using percentages, addition, subtraction, multiplication, division in all units of measure, using whole numbers, common fractions, and decimals.
- Ability to listen and understand directions.
- Ability to retain knowledge from past training and experience as well as comprehend and retain new training and learning experiences.
- Ability to maintain consistent focus on details.
- Ability to utilize and research existing department, client, and payer resource documentation to answer or clarify questions, as well as organize and optimize training notes, guidelines, and best practices / action steps needed when resolving denials.
- Ability to multi-task and work in a high-volume, time-sensitive environment.
- Self-motivated and able to work independently to complete tasks and respond to department requests.
- A positive attitude and ability to work within a team environment and individually.
- Understanding of internal business processes and related controls.
- Adapt easily to change in a fast-paced environment.
LANGUAGE SKILLS
- Ability to converse and respond to common inquiries from senior management and all other internal customers.
- Ability to communicate concisely, and effectively, both verbally and written, utilizing proper grammar and telephone etiquette to insurance companies, internal staff, and the public.
- Ability to use interpersonal skills to handle sensitive and confidential situations.
- Ability to write business-related documents such as letters, emails, and other business correspondence as needed.
REASONING ABILITY
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
PHYSICAL DEMANDS
The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to sit, talk, see, and hear. The employee frequently is required to use their hands to dial a telephone, utilize a computer keyboard and mouse, and operate office equipment. The employee is occasionally required to stand, walk, and reach with hands and arms and lift up to 20 pounds.
The employee works remotely from a suitable, comfortable environment that meets health and safety requirements and is in compliance with applicable employment laws in the employee's state of residence. The employee is expected to sit at a designated secure workspace during regularly scheduled work hours, communicate through phone or computer-based calling systems, type on a standard keyboard, and read and comprehend information from a computer screen and/or digital resources. This position adheres to all relevant state-specific regulations regarding work hours, breaks, and other employment standards.
COMPENSATION & BENEFITS
- Market competitive compensation program.
- Health, Gym discounts, Dental, Vision, Life, Health Savings Account, Flexible Spending Account, 401(k), Paid Time Off, Paid Holidays, & More.
The company extends equal employment opportunities to qualified applicants and employees on an equal basis regardless of an individual's age, race, color, sex, religion, national origin, disability, veteran status, sexual orientation, gender identity, gender expression, or any other reason prohibited by law.
Required
Required
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Thought Provoking: Capable of making others think deeply on a subject
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Team Player: Works well as a member of a group
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Enthusiastic: Shows intense and eager enjoyment and interest
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Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
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Dedicated: Devoted to a task or purpose with loyalty or integrity
Required
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Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work
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Self-Starter: Inspired to perform without outside help
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Goal Completion: Inspired to perform well by the completion of tasks
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Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Preferred
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Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
