Insurance Follow-Up Specialist

Insurance Follow-Up Specialist - 15450

US:DE:Dover | Clerical/Administrative Support | Full Time

Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: 30 Old Rudnick Ln

Status: Full Time 80 Hours

Shift: Days

SALARY RANGE: 19.18 - 28.77HOURLY

General Summary:

The Insurance Follow-Up and Collections Specialist is responsible for following up on all hospital and/or professional insurance claims. The position requires advanced knowledge of all payers and claim types, and the ability to prioritize workflow to meet insurance company filing deadlines for claim submission, claim reconsiderations, and appeals, and achieve targeted receivables monthly, and expedite cash flow. Specific duties involve researching unpaid claims, responding to insurance company information requests, submitting reconsiderations for partially paid claims, interpreting payer denials and reviewing medical records as appropriate, appealing denied claims and resolving payment variances as encountered to facilitate timely patient billing. As needed, the Specialist will make accurate recommendations for system or process changes to mitigate denials. The Specialist also serves as a subject matter expert for colleagues concerning expected reimbursement, denials, and other insurance company contract requirements and/or conflicts.

Responsibilities:

1. Follows up on unpaid claims and appeals via telephone or web-based claim inquiries. Completes imaging system correspondence work queue(s) as appropriate. Identifies and performs appropriate contract and/or other denial related write offs. Research missing payments via undistributed work queues and apply the payment to the correct invoice. Documents accounts thoroughly and appropriately with all information concerning claim and expected payment status and necessary follow up action taken to secure payment. 2. Verifies insurance eligibility, corrects claim errors, submits claim reconsiderations, writes appeals, and provides requested information to resolve denied claims. Interacts with various long term care offices to correct denials as appropriate. 3. Interprets payer denials, reviews submitted claim information, and medical records to understand the denial. Refers denied claims to correct department work queue with coding recommendations or other clarification questions as needed to resolve the denial; resubmits denied claims with revised information. Refers patients for Financial Assistance based on Medicare/Medicaid benefits exhausted and delayed lower level of care placement scenarios. 4. As applicable, converts denied inpatient admissions to observation claims based on the insurance company approving observation. 5. Contacts patients to resolve insurance company-initiated information requests as needed to facilitate claim payment. 6. Reviews and interprets Federal and State regulations for Medicare and Medicaid and contract terms for Managed Care, Commercial, and Workers Compensation as applicable. 7. Understands Bayhealth's contracted reimbursement rates. Reviews insurance company payment variances and, as needed, calculates expected reimbursement for outlier claims and claims with days denied as not medically necessary. Pursues underpaid claims and submits overpayments for refunds. Documents inappropriate denial and payment variances on spreadsheets, participates in calls with insurance company provider representatives, and accurately communicates variance reasons and expected resolution. 8. Processes credit balances; submits overpayments electronically to insurance companies who require electronic submission to correct the overpayment. As applicable, reviews the third-party vendor submitted refunds for accuracy. 9. Escalates insurance company and internal claim related issues to management as appropriate for resolution. 10. Serves as a subject matter expert for colleagues internal and external to PFS. Accurately researches payer issues and provides payer/plan specific education on billing and/or claim requirements. Ensures requests for system and process changes are thoroughly examined before making management recommendations. 11. As appropriate, performs Medicare and Medicare Advantage transfer DRG recoveries. Thoroughly researches the Medicare Direct Data Entry system, contacting sub acute facilities and home health agencies as needed to determine revenue recovery opportunities. Submits necessary adjusted claims to recover withheld revenue within payer filing limits. Tracks all claim findings and results in Excel spreadsheet and reports results to management monthly. 12. Maintains established department productivity minimums. 13. 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 ;
• Credential(s): ;
• Experience: Required: Three years' experience in hospital and/or physician billing and collections.
• Preferred: Four years hospital billing or collections experience.

Preferred Education, Credential(s) and Experience:

• Education: Associate Degree
• Credential(s): Certified Revenue Cycle Specialist
• Experience: