Follow-Up Specialist

Position Summary: Follows up on outstanding payments due on all types of open medical insurance claims, i.e., managed care and commercial. Coordinates activities with external insurance companies for the resolution of patient account balances. Ensures compliance with managed care guidelines and MMC organizational policies. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision, and values. USD $18.34/Hr. - USD $28.42/Hr. Qualifications Education: Education equivalent to graduation from high school or GED is required. Experience: Two or more years as an Account Follow-Up Specialist, or comparable years of medical insurance and/or health care billing experience is required. Possesses the technical knowledge to independently process claims of any denomination, type, and complexity is required. Knowledge, Skills, and Abilities Demonstrates thorough knowledge of the electronic billing system, medical terminology, medical procedural (CPT) and diagnosis (ICD‑9 CM) coding, DRGs and hospital billing claim form UB‑04 is required. Demonstrates a thorough knowledge of contract management systems and Blue Cross and Tricare guidelines. Basic working knowledge of personal computers and their associate user software is required. Experience with Microsoft Office products Word and Excel is preferred. Ability to work within the guidelines of defined managed care contract policy provisions and company procedures. Demonstrated ability to work successfully with internal customers and external contacts is required. Possesses highly‑developed prioritization and organization skills and critical thinking and problem‑solving ability. Demonstrates excellent communication skills, including telephone etiquette, and keyboarding and basic math skills. Responsibilities Access external insurance providers’ websites to determine and/or verify patients’ insurance eligibility and account status. Receive and examine daily listings for all denominations and types of patient accounts and determine which require further analysis and action. Investigate assigned patient accounts with incomplete/incorrect information and resolve problems or errors to ensure complete and compliant information accompanies the claim. Follow up and investigate all denominations and types of unpaid items and other issues associated with unpaid claims. Contact patients, guarantors, or other sources of third party payment and secure arrangements for prompt payment. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision, and values: SAFETY: Prevent Harm – I put safety first in everything I do. I take action to ensure the safety of others. COURTESY: Serve Others – I treat others with dignity and respect. I project a professional image and positive attitude. QUALITY: Improve Outcomes – I continually advance my knowledge, skills and performance. I work with others to achieve superior results. EFFICIENCY: Reduce Waste – I use time and resources wisely. I prevent defects and delays. Receive and research insurance claim denials, rejections and underpayments, and as necessary, prepare the necessary paperwork to appeal the denial. Review correspondence relating to payments and claims; conduct the necessary research to provide supplementary background information regarding the inquiry. Research and resolve complex issues associated with patient insurance accounts. As applicable, identify, document, and report problematic trends to management. Analyze reports containing rejected account information and perform the necessary research to resolve the reason(s) for the rejection and secure any other required information. Provide input regarding system edits designed to identify and ensure consistent and compliant data necessary for processing medical insurance claims. Respond to requests from internal departments regarding the proper coding, billing, and processing of medical insurance claims. Communicate and resolve issues with a variety of internal and external sources to resolve issues involving medical insurance claims. This may include internal departments, patients (or other responsible parties), third‑party payors, social service agencies, Medicare/Medicaid staff, other insurance carriers, service providers, and collection agencies. Initiate corrections to all denominations and types of charges and contractual/allowances within scope of expertise and authority granted. Identify and calculate write‑off amounts and secure the necessary approvals from management for processing. Document online systems and electronic files to ensure accurate data is noted regarding the status of claims and payments. Research complex issues on all denominations and types of accounts and coordinate their resolution in a timely manner. Ensure compliance to managed care contract guidelines and processes at each work step to facilitate accurate and timely reimbursements to the organization. May assist with special projects, analyses, or audits. As directed and defined by management, orient and cross‑train on other unit duties which are outside of regularly assigned area of responsibility. May serve as a back‑up for other areas within the unit or department, especially during times of special needs or staff absences. Perform other related work as required or requested. #J-18808-Ljbffr