Location: 30 Old Rudnick Ln
Status: Full Time 80 Hours
Shift: Days
General Summary:
The Insurance Follow-Up and Collections Representative is responsible for the follow up on all hospital and/or professional insurance claims. The position requires entry level knowledge of all payer and claim types and the ability to prioritize work flow to meet insurance company filing deadlines for claim submission, claim reconsiderations and appeals and achieve targeted receivables on a monthly basis and expedite cash flow. Specific duties involve researching unpaid claims, responding to insurance company information requests, submitting reconsiderations for partially paid claims, appealing denied claims and resolving payment variances as encountered to facilitate timely patient billing.
Responsibilities:
1. Follows up on unpaid claims and appeals via telephone or web based claim inquiries.
2. Verifies insurance eligibility, corrects claim errors, submits claim reconsiderations, writes appeals and provides requested information to resolved denied claims. Interacts with various long term care offices to correct denials as appropriate.
3. Refers denied claims to correct department work queue as needed to resolve denied claims.
4. Completes imaging system correspondence work queue(s) as appropriate.
5. Contacts patients to resolve insurance company initiated information requests as needed to facilitate claim payment.
6. Reviews and interprets contract terms for Managed Care, Commercial, Medicare, Medicaid and Workers Compensation as applicable.
7. Reviews insurance company payment variances; pursues underpaid claims and submits overpayments for refunds.
8. Processes credit balances; submits overpayments electronically to insurance companies who require electronic submission to correct the overpayment. As applicable, reviews third party vendor submitted refunds for accuracy.
9. Identifies and performs appropriate contract and/or other denial related write offs. Researches missing payments via undistributed work queues and apply payment to correct invoice.
10. Documents accounts thoroughly and appropriately with all information concerning claim and expected payment status and necessary follow up action taken to secure payment.
11. Escalates insurance company and internal claim related issues to management as appropriate for resolution.
12. Documents inappropriate denial and payment variances on spreadsheets.
13. Maintains established department productivity minimums.
14. All other duties as assigned within the scope and range of job responsibilities
Required Education, Credential(s) and Experience:
- Education: High School Diploma or GED
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- Credential(s): ;
- Experience:
Required: No experience required.
Preferred: One year experience in medical billing and collections, medical bad debt collections or intern/externship of medical billing experience related to a certification program.
Preferred Education, Credential(s) and Experience:
- Education:
- Credential(s):
- Experience:
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