Insurance Follow-up Specialist

Job Title

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.

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.

Position Type/Expected Hours of Work

This is a full-time position. Each employee's schedule must be between the hours of 6:00 AM PST to 9 PM PST, Monday through Friday with the specific schedule for each employee to be agreed upon by the employee's manager and the employee, taking into account the needs of the client. This position occasionally requires long hours and weekend work.

Required Education and Experience

Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing. Must have industry knowledge of guideline requirements for Medicaid, Medicare, commercial payors and HIPAA. Minimum 2-3 years' experience in Denials Management/Collections/AR Follow-up and experience with standard office software products. High School diploma or equivalent.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Physical demands include standing, walking, sitting, using hands, lifting up to 25 pounds.