Medical Billing and Follow Up Representative

Job Title: Medical Billing and Follow Up Representative

Department: MARS Insurance

Location: Remote

Schedule: Monday-Friday 7:00AM - 5:00PM CST

Supervisor: MARS Supervisor

FLSA Status: Non-exempt

Summary

Responsible for claim billing, follow up, and/or denial management, within the scope of the project assigned, for all payers by performing the following duties.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Review patient balance for accuracy and completeness and obtain any missing information.
• Submission of claims in a timely manner.
• Identify issues with accounts from explanation of benefits and denials.
• Check each insurance payment for accuracy and compliance with contract discount.
• Call insurance companies regarding any discrepancy in payments if necessary.
• Identify and bill primary and secondary insurances.
• All accounts are to be reviewed for insurance or patient follow-up.
• Answer all insurance telephone inquiries pertaining to assigned accounts.
• Conduct status checks with insurance companies and determine if appeal process is available.
• Document all activities within the account thoroughly.
• Review and complete all assigned work queues and tasks.
• Communicate with leadership any trends, questions or concerns.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data.

Continuous Learning - Assesses own strengths and weaknesses; seeks feedback to improve performance; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.

Job Knowledge - Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; keeps up to date on current developments; requires minimal supervision; displays understanding of how job relates to others.

Use of Technology - Demonstrates required skills; adapts to new technologies; troubleshoots technological problems; uses technology to increase productivity; keeps technical skills up to date.

Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.

Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance; meets commitments.

Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed.

Cooperation - Establishes and maintains effective relations; exhibits tact and consideration; offers assistance and support to co-workers; works cooperatively in group situations; works actively to resolve conflicts.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; participates in meetings.

Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.

Written Communication - Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.

Conflict Resolution - Encourages open communications; confronts difficult situations; maintains objectivity; keeps emotions under control; uses negotiation skills to resolve conflicts.

Diversity - Shows respect and sensitivity for cultural differences; promotes a harassment-free environment.

Ethics - Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.

Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values; benefits organization through outside activities; supports affirmative action and respects diversity.

Adaptability - Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.

Achievement Focus - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence; recognizes and acts on opportunities.

Personal Appearance - Dresses appropriately for position; keeps self well groomed.

Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals.; completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; looks for and takes advantage of opportunities; asks for and offers help when needed.

Innovation - Displays original thinking and creativity; meets challenges with resourcefulness; generates suggestions for improving work; develops innovative approaches and ideas.

Judgment - Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process.

Planning/Organizing - Prioritizes and plans work activities; uses time efficiently; sets goals and objectives.

Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.

Quantity - Meets productivity standards; completes work in timely manner; strives to increase productivity.

Safety and Security - Observes safety and security procedures; determines appropriate action beyond guidelines; reports potentially unsafe conditions; uses equipment and materials properly.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High school diploma or general education degree (GED) and billing background required; and two years’ experience in clearinghouse or denial management.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions,

proportions, percentages.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should have knowledge of Database software.

Technology Needs

Internet

Mobile device with MFA app capabilities

Certificates, Licenses, Registrations

Favorable Criminal Background Investigation results

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee must regularly lift and/or move up to 10 pounds. Specific vision abilities required by this job include that to work with computers.

Office Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.