What are the responsibilities and job description for the Insurance Follow-Up Rep position at Careers Integrated Resources Inc?
Description
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Job Summary: -Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances. -Other duties as assigned. -Answers patient calls and researches and responds to patient concerns within 24 working hours. -Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule and surgical group methodologies. -Applies knowledge for accurate resolution of claims within contract terms. -Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Mannual), HMO/PPO agreements and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals. -Serves as back-up to person primary on taking incoming calls. -Monitors queue light to ensure minimal wait times for patients in call queue. -Identifies denial trends and reports issues to Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons. -Participates in cross-training efforts for specific systems based on goals set by the PFS department. -Addresses accounts qualifying to workstation within one week utilizing system specific follow up procedures. -Coordinates efforts with ancillary departments as needed in a timely manner for effective resolution. -Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients. -Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions. -Updates and verifies payor specific account information.
Skills
====
Required Skills & Experience: -Two years of business office experience in billing, customer service, or collections in a healthcare environment. Preferred Skills & Experience: -N/A
Required
OFFICE EXPERIENCE
CUSTOMER SERVICE
CLAIMS
BILLING
MANAGED CARE
Additional
COLLECTIONS
CONTRACTS
INCOMING CALLS
RETAIL SALES
CREDIT SCORES
CODING
CREDIT TASKS
CUSTOMER SERVICE ORIENTED
AUTO INSURANCE
PFS
CUSTOMER INQUIRIES
CREDIT ISSUES
Education
========
Required Education: -High School Diploma or equivalent. Preferred Education: -N/A Required Certifications & Licensure: -N/A Preferred Certifications & Licensure: -N/A
Languages
=========
English( Speak, Read, Write )
=========
Job Summary: -Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances. -Other duties as assigned. -Answers patient calls and researches and responds to patient concerns within 24 working hours. -Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule and surgical group methodologies. -Applies knowledge for accurate resolution of claims within contract terms. -Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Mannual), HMO/PPO agreements and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals. -Serves as back-up to person primary on taking incoming calls. -Monitors queue light to ensure minimal wait times for patients in call queue. -Identifies denial trends and reports issues to Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons. -Participates in cross-training efforts for specific systems based on goals set by the PFS department. -Addresses accounts qualifying to workstation within one week utilizing system specific follow up procedures. -Coordinates efforts with ancillary departments as needed in a timely manner for effective resolution. -Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients. -Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions. -Updates and verifies payor specific account information.
Skills
====
Required Skills & Experience: -Two years of business office experience in billing, customer service, or collections in a healthcare environment. Preferred Skills & Experience: -N/A
Required
OFFICE EXPERIENCE
CUSTOMER SERVICE
CLAIMS
BILLING
MANAGED CARE
Additional
COLLECTIONS
CONTRACTS
INCOMING CALLS
RETAIL SALES
CREDIT SCORES
CODING
CREDIT TASKS
CUSTOMER SERVICE ORIENTED
AUTO INSURANCE
PFS
CUSTOMER INQUIRIES
CREDIT ISSUES
Education
========
Required Education: -High School Diploma or equivalent. Preferred Education: -N/A Required Certifications & Licensure: -N/A Preferred Certifications & Licensure: -N/A
Languages
=========
English( Speak, Read, Write )
