At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.
Position Summary: The Insurance Follow–up Representative’s responsibility is to reduce outstanding insurance due balances accurately and in a timely fashion to ensure a positive cash flow for the regional healthcare systems.
Duties and Responsibiliites:
Demonstrates Competency in the Following Areas:
1. Contacts insurance companies to follow up on third party balances according to stratified processing environment principals.
2. Uses all available technology (i.e., phone, web based systems, BLAST) to contact the appropriate agency/company to resolve account collection problems.
3. Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers and patients on patient 's account.
4. Achieves a Quality Review score of 2.8 or better, 90% of the time.
5. Maintains WIP counts at or below goal.
6. Maintains productivity stats at or above baseline goals.
7. Maintains insurance company master according to departmental name and address standards.
8. Review and resolve credit balances according to departmental guidelines.
9. Reviews rejections from third party payors, acting appropriately on those when necessary.
10. Maintains a problem log to include all denials, claim issues, registration errors and other issues for monthly reporting to individual departments/practices.
11. Stays informed of changes in the insurance industry.
12. Consults with other CMMF departments to obtain, verify billing information.
13. Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage; ensures confidentiality of patient records.
14. Maintains a professional, working relationship with the insurance companies, government agencies and third party payers.
15. Processes and completes all job responsibilities in compliance with regulatory requirements.
16. Works independently to resolve account problems.
17. Demonstrates the ability to be flexible, organized and function well in stressful situations.
18. Communicates clearly and accurately with the Supervisor.
19. Maintains a good working relationship within the department and with other departments of the Central Maine Medical Family.
20. Always accepts other assignments as needed.
21. Provides coverage for other team members when necessary, reorganizing work flow as necessary to accomplish this.
22. Customer Service: Interacts with all individuals in a consistent manner, providing attention, support, and assistance to foster an environment of exceptional personal service.
a. Maintains a pleasant and helpful demeanor, and presents a professional appearance toward all internal and external customers at all times.
b. Consistently initiates interaction to provide assistance to individuals who may not be direct customers of the employee (i.e. asks patients who appear to be lost if they need assistance in finding their way).
c. Takes appropriate action to recover from a service difficulty, ensuring that the necessary action is taken to affect a resolution to the customer’s problem.
d. Conducts all work activities with respect for coworkers, including the maintenance of a pleasant and professional environment, fostering calmness during stressful situations.
e. Interacts with supervisory personnel in a professional, supportive and courteous manner, venting emotions appropriate to time and place.
f. Demonstrates a commitment to service by consistent attendance and punctuality, scheduling absences according to departmental requirements, and incurring unplanned absences only when unavoidable circumstances exist.
Organizational Requirements:
23. Adheres to departmental dress code; appearance in neat and clean.
24. Completes annual departmental and organizational educational requirements.
25. Uses computerized Time Care System/edit log appropriately.
26. Maintains regulatory requirements.
27. Reports to work on time and as scheduled; completes work with designated time frame.
28. Wears identification while on duty, uses computerized punch time system correctly.
29. Completes in-services as required and returns in a timely fashion.
30. Attends a minimum of 90% of staff meetings annually. Reads and returns all monthly staff meeting minutes.
31. Represents the organization in a positive and professional manner.
32. Actively participates in performance improvement and continuous quality improvement (CQI) activities.
33. Complies with all organizational policies regarding ethical business practices.
34. Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department.
35. Confidentiality: Maintains confidentiality of information at all times.
a. Consistently maintains confidentiality of all information gained during the course of employment, respecting the privacy of others.
b. Understands and maintains the confidentiality of information communicated directly from the supervisor, including discussions of a counseling nature.
c. Follows policies and procedures related to medico legal matters, including confidentiality, amendments of medical records, patient rights, medical records as legal evidence and informed consent
d. Copies records according to policy, assuring the appropriateness of the individual requesting information from the record prior to copying, faxing, or phoning any portion of the record.
36. Safety: Demonstrates an understanding of fire and electrical safety, infection control, body mechanics, and related areas, as appropriate to position.
a. Attends mandatory in-services on fire safety, electrical safety, infection control, and body mechanics. Successfully completes competency-based training in each area.
b. Follows all employee health procedures, incident reporting, and infection control requirements at all times, as appropriate to the position.
c. Uses proper body mechanics at all times as required by the physical demands of the position.
d. Maintains a safe work environment and performs duties of the position in a manner consistent with ensuring the safety of self and others.
e. Identifies safety needs in areas outside own work environment, recommending corrective action as appropriate.
37. Expense Control: Performs job duties in a manner that maximizes expense control.
a. Uses supplies, equipment, and utilities in an expeditious manner
b. Consistently recommends methods to control costs while maintaining a high degree of customer service.
c. Performs job tasks efficiently and effectively resulting in no unplanned overtime.
Regulatory Requirements:
• High school graduate or equivalent.
• Minimum of two years relevant experience, including knowledge of insurance billing and medical terminology.
• Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid.
Language Skills:
• Able to effectively communicate in English, both verbally and in writing.
• Strong written and verbal skills.
• Additional languages preferred.
Skills:
• Basic computer knowledge.
• High level of interpersonal and communication skills.
Physical Demands:
• For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.
If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!