25508827 - Insurance Follow-Up Rep Cancelled
Country: United States
Other duties as assigned.
- Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.
- 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 Manual), 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 que light to ensure minimal wait times for patients in call que.
- 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.
- Two years of business office experience in billing, customer service, or collections in a healthcare environment is required.
- High School diploma or equivalent is required.