Insurance Follow-up Specialist

Description

POSITION SUMMARY

Insurance Follow-up Specialists are responsible for hospital and physician billing and collecting. The duties include working with payers to resolve issues and facilitate prompt payment of claims. Thorough knowledge and understanding of insurance billing, claims submission, and payer specific requirements is a must. This position is highly focused on the resolution of insurance processing errors and denials. Payers include but are not limited to Medicare, Medicaid, Blue Cross, and commercial health insurance carriers.

ESSENTIAL FUNCTIONS

• Verifies accuracy of billing data and revises any errors. Ensure all claims are transmitted and rejections are worked timely.
• Analyzes and follows-up on pending insurance claims utilizing the appropriate pending reports or system.
• Performs ongoing monitoring of accounts worked to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken.
• Utilizes all appropriate systems to effectively research accounts and complete steps to submit information necessary to payers to process accounts.
• Completes follow-up with patients, as necessary, to obtain additional information.
• Completes and/or requests adjustments to an account, as appropriate, based on the dollar threshold of the adjustment.
• Troubleshoots and resolves issues with any of the patient billing processes.
• Process and follow up on payer denials as needed.
• Maintain confidentiality of patient and company information.
• Reacts positively to change.
• Maintains knowledge of and follows policies, procedures, Code of Conduct, and all Federal and state rules and regulations related to the position.
• Completes all required compliance training.
• Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

Qualifications

KNOWLEDGE, SKILLS, & ABILITIES 

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, skills and/or abilities required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Familiarity with deductibles, contractual adjustment, insurance plans, and procedures
• Good problem solving and analytical skills
• Detail oriented with strong organizational and follow-up skills
• Good interpersonal and customer service skills
• Good computer skills 
• Ability to adapt to changing insurance regulations
• Ability to discuss collections with patients in a confident manner
• Ability to speak, read, and write in English
• Ability to effectively communicate both orally and in writing
• Ability to operate standard office equipment 
• Ability to concentrate, think, and learn
• Ability to hear, see, sit, stoop, kneel, crouch, reach, lift, push, and pull. 

EDUCATION AND/OR EXPERIENCE

High School diploma or equivalent is required; a minimum of three (3) years experience in medical billing and collections is preferred; medical insurance knowledge is required; and/or equivalent education or experience in job related activities is required.