Insurance Follow Up Rep

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
• Assists with unusual, complex or escalated issues as necessary.
• Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
• Accurately documents patient accounts of all actions taken in billing system.
• Other duties as assigned by leader and organization.

• Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
• Knowledge of medical insurance, payer contract, CPT and ICD codes.
• Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
• Knowledge of the operation and application of automated systems applicable to the assigned function.
• Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
• Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
• Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
• Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
• Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
• Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
• Ability to effectively prioritize and execute tasks while under pressure.
• Ability to demonstrate excellent customer service skills, including professional telephone interactions.
• Ability to read, understand and communicate in English sufficient to perform the duties of the position.
• Ability to establish and maintain effective working relationships as required by the duties of the position.

CommonSpirit Health