Virtual Insurance Professional

Under limited supervision the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in filing insurance claims, determining correct reimbursements/ adjustment/write-offs, and denial management. They also analyze plans to determine which benefits are covered, submit secondary insurance claims, generate patient statements, and follow-up on those submissions.

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.

Maintain a working knowledge of client policies and procedures. Maintain quality standards as determined by management.

Maintain accurate records within a collections database.

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

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

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

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.

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.

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. 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.

Travel

Minimal travel required; 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.

In addition to the specific security access required by the employee's client engagement, the employee will have access to the Omega set forth in the "Standard Field Employee" profile.

All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at View email address on click.appcast.io in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at View email address on click.appcast.io Field Employees - Hourly X4E

Full-Time/Part-Time Part-Time