The position is available for remote work at the following states: Florida, Tennessee, Texas, Wyoming
Kentucky- (Must be located within 30 miles of Campbellsville, KY)
South Carolina (Must be located within 30 miles of Aiken, South Carolina)
POSITION SUMMARY
The Insurance Follow-Up Representative performs medical claim denial management and follow-up services for various clients. The actual work performed will depend on client needs and currently active projects, and projects could be long-term or short-term. This position requires knowledge of the Uniformed Bill and HCFA claim billing forms, timely filing limits set forth by various payers, various payor websites for follow-up and research, and general insurance 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 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
- Medicare and Managed Medicare, Medicaid and Managed Medicaid, Government, Commercial, MVA, Workers’ Compensation, and other Third-Party Liability payers.
- 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 appeals 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 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 contribute 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.
- Effectively acts as a resource to peers and assist others in growth and development of insurance follow-up related skills
- On a quarterly basis, exceeds expectations in productivity and quality performance metrics established by management.
- Performs other duties as assigned.
Work Hours: 8:00AM - 5:00PM EST, Monday – Friday
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 3-5 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 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.
WORK ENVIRONMENT
The employee works in a temperature-controlled office environment. The employee sits at a desk during regularly scheduled work hours, answers and makes telephone calls using a standard telephone, types on a standard keyboard, and reads and comprehends information from a computer terminal and/or written resources.
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.
