Insurance Follow-up Specialist

Essential Job Functions

Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.

Analyze claims (denial/non-denial) in practice management systems, internal system and direct toward resolution (Payment, Adjustment & self-pay).

Technical billing and denial follow-up on all assigned payer claims

Call Payer (Insurance/ third parties) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay).

Identify potential process improvements, trends, issues and escalate to Supervisor.

Be part of initial and all ongoing training sessions to enhance knowledge of RCM processes.

Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account transactions.

Identify trends/payer issues and escalate complex payer issues to the Supervisor, as necessary.

Maintain a working knowledge of client policies and procedures. Follow the Workflow documentation like SOP’s Update tracker, Issue Log and Trend logs.

Maintain quality standards as determined by management.

Assist the Manager or Supervisor in working priority reports promptly, effectively, and efficiently.

Maintain accurate records within a collections database.

Be a mentor to new employees and assist in their training and development.

Performs other duties as directed.

Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

Key Success Indicators/Attributes

Ability to prioritize and multi-task in a fast-paced, changing environment.

Demonstrate ability to work in all work types and specialties.

Demonstrate ability to self-motivate, set goals, and meet deadlines.

Demonstrate leadership, mentoring, and interpersonal skills.

Demonstrate excellent presentation, verbal, and written communication skills.

Ability to develop and maintain relationships with operations business partners by building personal credibility and trust.

Maintain courteous and professional working relationships with employees at all levels of the organization.

Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.

Demonstrate excellent analytical, critical thinking and problem-solving skills.

Manage the Individual KRA’s as per the provided metrics.

Meet the productivity and quality targets of clients within the stipulated time. Ensure timely follow-up on pending claims and prepare and maintain individual status reports.

Skill in operating a personal or company owned computer and utilizing a variety of software applications is essential.

Supervisory Responsibility

No

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. The use of a second monitor is required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.