Claims Follow-up Specialist

Summary

Objective: The Claims Follow-up Specialist follows-up on Medicare/Medicaid, Blue Cross Blue Shield, Patient Pay and Commercial Payers to effectively and professionally resolve customer and insurance companies’ questions and inquiries.

Essential Duties:
 Know and support the Mission Statement, Policy/Procedures and standards of MMR.
 Maintain HIPAA compliance.
Medicare/Medicaid follow-up:
 Complete Medicare over 50 mile requests, process follow up rejections/denials and appeals for Medicare and Medicaid claims.
 Process Medicare and Medicaid refunds.
 Follow-up on lacking Medicare Signatures via mail/phone calls.
 Final person to answer incoming customer service phone calls. Assist incoming calls and provide assistance to patients, payers and others as needed.
 Process credit card payments.
 Facilitate payment for services rendered by soliciting payment in full from incoming calls and, when appropriate, establish payment arrangements or seek completion of a charity questionnaire.
 Contact patients and/or insurance company to obtain the correct billing information.
 Resubmit accounts when new or corrected information is obtained from the caller or payer.
 Enter patient demographics as required from information gathered from correspondence or telephone contacts.
Blue Cross Blue Shield (BCBS) follow-up:
 Complete BCBS/Patient Care Report (PCR) information requests.
 Process BCBS rejections/denials.
 Process BCBS refunds.
 Third person to answer incoming customer service phone calls. Assists incoming calls and provide assistance to patients, payers and others as needed.
 Process credit card payments.
 Assist incoming calls and provide assistance to patients, payers and others as needed.
 Facilitate payment for services rendered by soliciting payment in full from incoming calls and, when appropriate, establish payment arrangements or seek completion of a charity questionnaire.
 Contact patients and/or insurance company to obtain the correct billing information.
 Resubmit accounts when new or corrected information is obtained from the caller or payer.
 Enter patient demographics as required from information gathered from correspondence or telephone contacts.
Commercial follow-up:
 Secondary Call Taker. Assists incoming calls and provide assistance to patients, payers and others as needed.
 Process mail returns.
 Follow-up with commercial payers including auto.
 Assists Patient Pay follow up as necessary.
 Process commercial insurance refunds.
 Process credit card payments
 Facilitate payment for services rendered by soliciting payment in full from incoming calls and, when appropriate,
establish payment arrangements or seek completion of a charity questionnaire.
 Contact patients and/or insurance company to obtain the correct billing information.
 Resubmit accounts when new or corrected information is obtained from the caller or payer.
 Enter patient demographics as required through information gathered from correspondence or over the phone.
Patient Pay follow-up:
 Primary call taker. Assist incoming calls and provide assistance to patients, payers and others as needed.
 Process return mail and change of address (NCOA).
 Place accounts in collections after determining that there is not active insurance to bill.
 Process patient refunds.
 Process credit card payments.
 Facilitate payment for services rendered by soliciting payment in full from incoming calls and, when appropriate,
establish payment arrangements or seek completion of a charity questionnaire.
 Contact patients and/or insurance company to obtain the correct billing information.
 Resubmit accounts with new or corrected information is obtained from the caller or payer.
 Enter patient demographics as required from information gathered from correspondence or telephone contacts.
 Perform other duties as assigned.

Knowledge, Skill and Competency Requirements:

Knowledge, Skill and Competency Requirements:
 Proficiency with billing the following insurances, Medicare, Medicaid, BCBS, Commercial
 Ability to communicate effectively both verbally and in writing, in a professional manner with customers and patients
 Must proficiently use insurance websites i.e., C-Snap, Champs, Web Denis, etc., 2 months after date of hire
 Reading skills to comprehend correspondence and materials specific to the healthcare industry
 Must demonstrate ability to maintain security and confidentiality with utmost discretion
 Ability to communicate effectively both verbally and in writing, in the English language
 Ability to organize tasks and insure timely completion of all projects
 Advanced computer skills including the ability to utilize a computer PC with Windows operating system
 Ability to operate office equipment, including but not limited to, copier, fax machine, scanner, monitor, multi-line
telephone, printer, typewriter and calculator
 Proficiency with Microsoft Word and Excel
 Regular attendance and timeliness
 Skilled in typing, data entry, scanning, electronic filing and document retrieval
 High School Diploma
 Must be at least 18 years old

Physical Factors: Suitable dexterity to operate standard office equipment. Capability to stand or sit for extended periods of time.

Working Conditions: Most work is done in a typical office setting with daily exposure in all other department areas. Regular, inperson
attendance is an essential function of the job. Materials and equipment used include desktop computer, telephone, fax,
copier, printer and other standard office equipment. Hours must be flexible to meet the demands of the office.