Follow Up Clerk Job Description Sample
Insurance Follow Up Rep
Responsible for daily follow-up and reconciliation of outstanding accounts to ensure accurate accounts receivable reporting.
The person in this position works under general supervision, is responsible for various shifts, may be subject to over 40 hours per week and/or callback as required, and may also be required to remain on campus immediately before, during, and after severe weather and/or disasters.
Requirements for Insurance Follow Up Rep:
High School Diploma or General Education Degree Required
Six (6) months of relevant healthcare revenue cycle experience (patient access, financial assistance, insurance billing, patient and/or insurance collections, reimbursement, health care customer service, payer contracting, or coding) is required. Experience with health care insurance collections preferred.
Must be able to demonstrate the following: Medical Terminology, Written communication skills, Verbal communication skills, Medicare regulations, Coding, Excel, WORD, Specific applications to use PC applications to achieve work goal, Office applications: email, fax module, scan PDF, Fast paced work environment, Meeting deadlines, Organized, Time management, Conforming to standards, Phone customer service, Billing process, Manage large data volume, Audit Techniques , Healthcare financial regulations, Insurance collections process, Patient privacy, Data entry,10 key calculator, Works well within a team structure.
Requirements for Insurance Follow Up Rep II:
High School Diploma or General Education Degree Required
Two (2) years relevant healthcare revenue cycle experience (patient access, financial assistance, insurance billing, patient and/or insurance collections, reimbursement, health care customer service, payer contracting, or coding) is required. Experience with health care insurance collections preferred. Less job experience is required with completed advanced education (Associates, Bachelors, or Masters' degree).
Must be able to demonstrate the following: Medical Terminology, Written communication skills, Verbal communication skills, Medicare
CRCS-I or P or CHAA Certification is required
regulations, Coding, Excel, WORD, Specific applications to use PC applications to achieve work goal, Office applications: email, fax module, scan PDF, Fast paced work environment, Meeting deadlines, Organized, Time management, Conforming to standards, Phone customer service, Billing process, Manage large data volume, Audit Techniques , Healthcare financial regulations, Insurance collections process, Patient privacy, Data entry,10 key calculator, Works well within a team structure.
Workers Compensation/No Fault Follow Up Specialist
Job Description: Great Lakes Medical Imaging, LLC
Title: Workers Compensation/No Fault Follow Up Specialist
Reports to: Billing Manager
Based at: GLMI Billing Office
Job description: Responsible for reviewing and fixing errored/rejected files from the clearing house, identifying, fixing and resubmitting denied claims, following up with insurance carriers regarding claims that have not been responded to, answering incoming patient phone calls
Key responsibilities and accountabilities:
Entry of EC4 claim information on WCB website
Follow up with WC/NF insurance carriers on unpaid accounts
Ability to use and understand insurance carriers websites
Ability to review and understand insurance EOB
Answer incoming patient phone calls
Ability to prioritize workload
Ability to focus and successfully meet monthly goals set by management
Ability to adhere to Policy and Procedures set companywide and interdepartmentally
Other duties as assigned by management
Education: High school diploma or GED
Skills/Experience: Knowledge of Excel. Ability to operate a computer and basic office equipment. Skill in answering a telephone in a pleasant and helpful manner. Ability to read understand and follow oral and written instructions. Ability to establish and maintain effective working relationships with patients and employees. Must be well organized and detail oriented. Must be able to multi-task.
Physical demands: Requires sitting and standing associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve.
Associate Rep, Account Follow Up
Associate Rep, Account Follow Up
Cancer care is all we do
Hope in healing
Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients' quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.
The Account Follow-up Rep (AFR) is responsible for the reimbursement and/or resolution of patient account balances and is accountable for complete follow-up tactics working accounts to exhaustion maximizing reimbursement. This role performs account management and analysis; as well as complete, timely, and accurate follow up of patient or insurance (hospital or physician) account balances with the objective of optimizing insurance reimbursement and ensuring that our patients receive the best CTCA has to offer in account management. An Account Follow-up Rep may be responsible for working account balances in any of the following areas:
Insurance Account Follow-up (hospital or physician), which may include a focus on claims denied by insurance carriers or paid incorrectly (underpaid).
Self-pay Account Follow-up focusing on the collection of the patient responsibility portion left by insurance leveraging assistance programs and tools. This area includes the inbound call center.
Administration of financial programs supporting the patient with medical balances such as Financial Assistance, Co-pay Assistance, Free Drug, Drug Replacement, etc.
The AFR interacts with, and leverages, external and internal sources to overcome barriers, problem solve, and ultimately resolve account balances. This includes patients, caregivers and family members, site stakeholders, contracted and non-contracted insurance, third party payers, and employers as necessary. They are expected to review and determine appropriate actions on assigned patient accounts at a minimum of every 45 days or as the collection process requires.
This role is accountable for understanding and reconciling insurance practices (contracted/non-contracted).
Confirming that a claim/account has been verified, billed, and paid correctly through analysis of payments and adjustments. The AFR will take the appropriate action to resolve claims that are not paid correctly as a result of denials or underpayment. This position is also responsible for ensuring that account statements are accurate and timely and with the appropriate statement message; that patients have an understanding of their balances and are appropriately engaged in appeals with insurance. The AFR provides assistance options to support patients with their financial responsibility where appropriate. Leveraging all available account follow-up and analysis options the AFR may ultimately determine that account balances are uncollectable. This can be through bad debt adjustment, month end review with the site CFO, or leveraging patient financial assistance programs.
The AFR is considered an agent acting on behalf of the patient, as well as CTCA, and therefore must exemplify the highest in CTCA standards to ensure a consistently positive patient experience. Serves as a direct point of contact for CTCA patients and regularly fields patient inquiries and complaints.
The Account Follow-up Rep reports directly to the Account Follow-up Supervisor.
1.Account Follow-up and Collections
Works assigned alpha, or account strategy as communicated by the Supervisor via the Account Trial Balance (ATB) and supporting systems (PIC).
Follow-up is completed on accounts/patients monthly or as directed based upon account follow-up strategy. Higher balances accounts may require more frequent follow-up, and the AFR will make a determination based on circumstances to touch an account multiple times within the month as the collection process requires.
Responsible for managing a portfolio of patient accounts with multiple touch points over an extended period of time.
Pursues insurance companies, patients or guarantors, PPO Networks, attorneys as appropriate for the purpose of expediting payment of CTCA receivables.
Accountable to productivity metrics associated with account reduction, collection metrics, and account aging.
May be responsible for follow-up on denied charges, utilizing CTCAs denials management technology, accessing denials via their work queue. This includes validation of denied charges, collaboration with site resources to ensure denials are appealed timely, regular payer follow-up regarding appealed account, medical records requests, and any short paid claim in an effort to obtain correct reimbursement expected.
When appropriate, will identify opportunities to negotiate with insurance in an effort to ensure fair and optimal reimbursement.
Responsible for identifying and recommending process improvements; and are assigned special projects or assignments from AM Supervisor or Director as requested.
Refer accounts/bills to Recovery Service Representatives for the purpose of filing and/or following up on liens, worker comp claims, litigation, collection issues etc.
Updates insurance information and routinely adds account comments to each account worked.
Responsible for timely and accurate documentation in applicable systems.
Works all incoming mail, 3rd party correspondence, and inbound call center if necessary and are available to provide back up if required to do so. All mail should be reviewed within 1 business day of receipt and any time sensitive issues must be addressed by the end of the business day.
All other correspondence worked by end of month, unless other authorization has been granted by supervisor or director as appropriate.
Through account follow-up identifies accounts where patients may be in need of assistance with their patient responsibility balances. The AMS is responsible for providing the patient with the appropriate information regarding the Financial Assistance program, determining eligibility, and communicating approval; as well as noting and updating the account appropriately.
Discounts may be offered to patients for full payment of patient responsibility balances, or discounts may be offered to patients to settle their patient responsibility balances prior to assistance being offered (applicable to patients with non-government payers).
Maintains current and complete understanding of general contract terms of reimbursement from managed care, government and third party payers.
Ensures that the terms of contract are met, and reimbursement is accurate.
Maintain the skill sets to perform verification of insurance coverage, to calculate payments received are equal to what is expected based on contract rates and patients benefit coverage as needed.
Performs research of incorrect payments, discounts and audits.
Is responsible for analyzing EOB's and determining if payment is correct.
Completes thorough account research and communicates regularly with multiple internal and external entities to bring accounts to resolution.
Identifies questionable accounts/bills, problematic payers or unusual situations and brings to supervisor or director.
Will identify and escalate any payer trends identified to resolve and/or mitigate issues.
Negotiates prompt pay discounts within guidelines established in CTCA AR and Billing policy, responds to all negotiation calls and faxes within 2 business days, unless other authorization has been granted as appropriate. Provides account background information in support of requests that must be escalated for approval.
Through account follow-up reconciles complete patient histories, routinely adds statement messages, sends letters, and makes out bound calls as appropriate and establishes both internal payment plans and extended time pays.
Assigns account to in-house, extended time pay, collection agency, appropriate denials management work queue's and litigation once identified, by the end of business day as appropriate, unless other authorization has been granted.
Brings requests to transfer accounts/bills out of bad debt status to supervisor for review.
Make recommendations for write-offs, litigation, and collection agency submission.
Reviews account details and submits the electronic adjustment log to shared drive the end of the business day, unless other authorization has been granted.
Prepares cash transfer requests.
Maintains relationships within Patient Accounts, RCM, and with Patients and Caregivers. Collaborates as needed with Care Managers, Pre-cert staff, Registration staff, Medical Records staff, Compliance.
Active collaboration is required across all Patient Accounts functions to ensure that accounts are appropriately managed.
This role may occasionally have contact with attorneys, county courts, insurance companies etc. for the purpose of collecting hospital and physician accounts/bills receivables.
Serves as the primary point of contact with CTCA patients regarding their accounts. This includes self-pay balance follow-up, coordination of benefits (COB), responding to patient inquiries, etc.
All patient calls must be returned within one business day and written requests within 3 business days. Are responsible to report any instances to their supervisor where they cannot meet these required time deadlines.
Meets with patients as required (either in office or in hospital environment).
Responsible for maintaining accurate patient demographics, patient confidentiality.
Maintains solid knowledge of operating all required computer applications and other systems as conversions may occur.
Attends department, team, stakeholder meetings and in-services or seminars as requested.
Adhere to written CTCA, and Patient Accounts/bills specific policies and procedures, CTCA Financial Policy and all HIPAA rules and regulations at all times.
Demonstrates the spirit of CTCA's values and standards through actions and speech and connect with patients, caregivers, co-works, payers with a smile or pleasant demeanor while also addressing them by their preferred names whenever possible.
Education and Experience
Must have a high school diploma/equivalent or passed proficiency exam.
Associates degree in related field is preferred. BA/BS is desired.
Must have a minimum of 3 years of A/R experience in a hospital or physician healthcare setting including insurance and self-pay healthcare collections/billing as well as insurance verification experience with demonstrated analytical capability.
Knowledge and Skills
Solid knowledge of medical terminology, ICD9 codes, CPT/HCPC's codes. Familiar with Medicare Bad Debt laws and requirements, and Fair Debt Collection Laws.
Understanding of insurance contracts and reimbursement methodologies.
Experience with account reconciliation and balancing.
Ability to interpret EOBs and navigate insurance patient insurance policies.
Knowledge of collection agency work, probate courts and its requirements, and bankruptcy laws and regulations.
Advanced written and verbal communication skills.
Proficient with technology, spreadsheet management skills, with the ability to analyze trends.
Excellent organizational skills, ability to manage multiple priorities and responsibilities.
Outstanding communication and customer service skills.
Must be willing to travel, as needed
We win together
Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you're ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us.
Visit: Jobs.cancercenter.com to begin your journey.
Insurance Follow Up And Collection Specialist
The Insurance Follow-Up and Collections Specialist is responsible for the follow up on all hospital and/or professional insurance claims. The position requires advanced knowledge of all payer and claim types and the ability to prioritize work flow to meet insurance company filing deadlines for claim submission, claim reconsiderations and appeals and achieve targeted receivables on a monthly basis and expedite cash flow. Specific duties involve researching unpaid claims, responding to insurance company information requests, submitting reconsiderations for partially paid claims, appealing denied claims and resolving payment variances as encountered to facilitate timely patient billing. The Specialist also serves as a subject matter expert for colleagues concerning expected reimbursement, denials and other insurance company contract requirements and/or conflicts.
Minimum Education and Experience:
High School diploma or GED
Three years' experience in hospital and/or physician billing and collections.
Four years hospital billing or collections experience.
Experience with medical billing and claims editing systems.
Intermediate experience with Microsoft Word and Excel.
Experience with Epic and xClaim.
AAHAM Certified Revenue Cycle Specialist (CRCS)
Special Knowledge, Skills, and/or Abilities:
Performs all areas of job functions at a high accuracy rate.
Knowledge of revenue-cycle, managed care environment, 3rd party reimbursement, and hospital financial resources.
Position requires comprehensive knowledge of applicable Federal, State and commercial insurance regulations, insurance plans, member eligibility and medical billing and collections.
Knowledge and understanding of CPT/HCPCS and ICD-10 codes, UB04 and CMS 1500 claim forms and the difference between technical and professional fee charges.
Exceptional written, verbal and interpersonal communication skills; must demonstrate ability to articulate information in a clear and informative manner.
Ability to read and interpret documents such as an Explanation of Benefits and/or Remittance Advice and properly identify denials and patient responsibility amounts from remittances required
Detail oriented, strong problem solving and analytical skills.
Ability to multitask and use multiple windows/programs at one time.
Billing Specialist III - Rev Cyc-Surg Follow Up
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
High School diploma or equivalent, Associates degree preferred, and six (6) years medical billing or collections experience. Two (2) years must include billing and or denials management for complex E&M services, diagnostic studies, and/or minor surgical procedures.
Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred. Requires working knowledge of Epic Resolute, EpicCare, and Epic CPOE. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.
Coding and multispecialty experience highly preferred.
Analyzes, investigates and resolves coding edits for complex diagnostic studies, endoscopic, interventional and/or surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution.
Requires strong knowledge of the carrier's (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and specialty specific service line billing practices. This position requires a high degree of organization and accuracy, and clear communication with providers on a regular basis to insure services are well documented and meet all billing requirements.
Performs abstracting on E&M services, complex diagnostic studies, and/or endoscopic, interventional or surgical procedures. Requires the ability to read the progress note and or procedure/surgical results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable). Requires strong knowledge of the carrier coverage policies and documentation requirements for specialty specific service lines. Must know the Medicare and Medicaid teaching physician documentation billing rules.
Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and Billing Specialists I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials, rejections and backend coding edits.
Performs manual charge entry for all non-EpicCare and non-automated sites of services. This includes E&M visits and procedures across several centralized service lines. Depending on the clinical department they may be required to review and release charges from a computer assisted coding environment.
Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic's carrier registration filing order rules and billing rules.
Periodically assists in obtaining insurance authorizations and accurately maintaining the authorization records, communicate patient balance and patient-responsibility amounts to clinics and/or patient/families, responding to requests for information. Attend coding and billing in-services to stay current on changes; attend other meetings and training as assigned.
Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
Other Duties: Performs other duties as assigned.
UTSouthwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.
Medicaid Follow Up, Accounts Receivable
The A/R Follow Up Specialist is responsible for the management of Medicaid accounts through written or verbal direction from patients, aged trial balance reports and Medicaid rejection reports for the accurate and timely filing of claims for maximum reimbursement. A/R Follow Up Specialists will have the ability to provide support to other Accounts Receivable departments, as needed. All staff must adhere to all department policies and procedures.
Customer service duties include answering telephones politely and confidently for patients and others regarding billing inquiries and resolving billing issues.
Act as a resource regarding Medicaid compliance guidelines.
Accurately enter information provided by various sources to correct claims in regards to CPT and ICD-10 codes and send out results in a timely manner to Medicaid.
Must be able to interpret and communicate Medicaid Explanation of Benefits.
Audits accounts showing Medicaid denials to resolve balances.
Resolve invoice issues from outside laboratories for Medicaid patients.
Submit and retrieve eligibility requests through Medicaid web portals.
Communicate with Team Lead and/or A/R Supervisor on areas that may be improved and appeals minimized.
Strong data entry skills, with the ability to meet production guidelines as set by A/R department policy.
Ability to stay focused and performs job duties efficiently and accurately.
Employee must comply with Sonic Healthcare USA's compliance policies and procedures.
Duties include but are not limited to the above mentioned responsibilities.
Perform other duties as assigned.
Knowledge of computer technology and terminology
Ability to type and demonstrate10 key proficiency
Perform duties in a timely and accurate manner
Maintain confidentiality of information
Ability to communicate effectively at all levels within the company, with patients and physician office staff
Possess effective work habits and ability to build/maintain work relationships
Ability to read and comprehend English
Ability to work under deadlines
- High School diploma or GED
- Typing (min 35 wpm) and 10 Key
2 years' experience in standard Medicaid or related Star plans environment
Experience with medical coding, private insurance, laboratory and/or medical billing
Customer service experience
Bilingual speaking skills/Spanish
Experience in multitasking environment
Scheduled Weekly Hours:
1st Shift (United States of America)
Sonic Healthcare USA, Inc
Sonic Healthcare USA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Insurance Follow Up Rep
Location: Service Center, Omaha NE
Position Type: Regular
Scheduled Hours per 2 week Pay Period: 80
Primary Location: NE > OMAHA > SERVICE CENTER-NORTH BLDG
JOB DESCRIPTION POSITION SUMMARY
This job is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues.
In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.
Uses and discloses patient protected health information: 1) Only as it applies to job functions, 2) in amounts minimally necessary for intended purpose, and 3) in a confidential manner.
ESSENTIAL JOB RESPONSIBILITIES
Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
Resubmits claims with necessary information when requested through paper or electronic methods.
Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
Assists with unusual, complex or escalated issues as necessary.
Required Education and Licensure
Required Minimum Experience
Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.
Graduation from a post-high school program in medical billing or other business-related field is preferred.
Requisition ID: 2019-R0228093
Shift: Day Job
Market: CHI Health
Follow Up Analyst -- 2019 Summer Vacation Replacement
The Follow Up Analyst -- Salary Bargaining Unit -- Summer Vacation Replacement (SVR) is a temporary responsible for performing follow up, shipping, record integrity, and (ASN) Advanced Shipping Notification reconciliation activities. Maintain cycle count compliance programs as well as in process and finished inventory balances on hand and accuracy. Monitor, track and trace all in/outbound shipments to the internal production departments.
Bachelor's degree or working toward the completion of a Bachelor's degree
Ability to work any shift and overtime as required
Excellent organizational, written and oral communication skills
Excellent interpersonal skills
Bachelor's degree or pursuing a Bachelor's degree in a manufacturing related field
Previous manufacturing supervisory experience
Demonstrated ability to coach/mentor/develop team members
Previous experience working in a union environment
Strong background in LEAN manufacturing systems
Proficient in Microsoft Office applications
Supervisor Collections & Follow Up Revenue Management
Status: Full Time Facility: Administrative Regional Training Cntr
Work Schedule: Days Shift: 1:
Exempt from Overtime: Exempt: Yes FTE: 1.000000: Bargaining Unit: ACE Associates
The Revenue Management Center supports the revenue cycle for all of the acute care sites and related departments, service lines and business units organized within the acute care sites of Mercy Hospital, Sisters of Charity Hospital including the St. Joseph Campus, Mount St. Mary's Hospital and Kenmore Mercy Hospital. Combined this consolidated base has approximately 1065 beds, over 55,400 annual inpatient visits, over 1.346 million outpatient visits and over 163,000 emergency room visits. In addition, Catholic Health also provides professional billing for approximately 350+ physicians and various mid-levels. This is an aspect of our organization that will continue to grow as we look to healthcare reform and the continued alignment of physicians with the healthcare system. This consolidation makes up approximately 90% of total Catholic Health Net Revenue in excess of approximately $1 billion annually.
This position will be the subject matter expert in supporting the staff including, but not limited to, the following items (1) State, Federal or other contracted follow up and collections requirements (2) Use of tools and technology in providing billing services (3) Workflows and worklists (4) Directing and identifying the correct course of action and/or individuals to work with to resolve issues (5) Appropriately resolving issues for the staff as front line resources to the staff and escalating timely if resolution needs the next level of management to resolve (6) Availability to the staff as a resource in addressing daily issues (7) Prioritizing work and directing work for the staff and (8) Representing one self as a role model to the staff in alignment with the culture of Catholic Health and our Value
- Associate's degree required
Minimum five (5) years of experience in business related field
Experience in Accounts Receivable medical billing required
Experience with business process re-engineering and change management desired
Experience with supervising teams
Demonstrated experience in mentoring staff
KNOWLEDGE, SKILL AND ABILITY
Strong communication skills
Process development skills
Strong interpersonal skills
Proficient with MS Office, most notably excel and word, preferred
Strong organizational skills
Problem Solving Skills
- Normal heat, light space, and safe working environment; typical of most office jobs.
Insurance Follow Up Specialist
Work Schedule/Days: Day / Monday
Employment Type: Full-Time
Location: Office Park (1455)
Requisition #: 32868
Meets all department collection and follow-up performance expectations. Completes assigned work in a timely fashion and reports any issues or obstacles to lead collector or patient accounts supervisor to ensure swift resolution. Identifies payor trends proactively in relation to zero payment, payment variance, billing, and denials. Works closely with other collectors and lead collectors in completing claims billing and follow-up collection activities. Completes projects as requested by patient accounts manager or patient accounts supervisor. Adheres to company and department attendance, basic work requirements, and other policies and procedures.
- High school diploma or equivalent
- No professional certifications required
- One year of experience in insurance billing or collections, with a general knowledge of hospital business office functions
Two years of experience in insurance billing and/or collections, with a general knowledge of hospital business office functions
Knowledge of key Children's Healthcare of Atlanta patient accounting applications, e.g., Epic Resolute, Dentrix Dental, Clearinghouse, or comparable system
KNOWLEDGE SKILLS & ABILITIES*
Knowledge of third-party requirements and policies, including Medicaid, Managed Care, Blue Cross Blue Shield, care management organizations, health maintenance organizations, preferred provider organizations, commercial payors, and self-pay
Must have excellent telephone communication and customer service skills
Excellent written and verbal communications skills
Familiar with medical terminology, including diagnosis and procedure codes
Must be able to meet department/individual goals
Must be able to type 45 words per minute
Must be able to operate personal computer-based systems, including working knowledge of word processing, spreadsheet, and billing software
Performs daily billing of claims to third-party insurance following the guidelines of the UB04 and HCFA 1500 manual.
Ensures that special billing needs by payor are performed to prevent denial of claims and delay in payment.
Prepares and submits all final bill claims, secondary claims, rebills, and late charges on a daily basis, maintaining a current status.
Performs routine follow-up on unpaid insurance claims, taking appropriate action to resolve problems causing delay in reimbursement.
Documents all telephone and correspondent communications with third-party payors and guarantors thoroughly via online activity codes.
Prioritizes and works proactively on accounts in assigned work queue to ensure all accounts are submitted in a timely manner.
Complies with department workflows and routines.
Contacts guarantors and other insured parties when additional information is needed, and takes appropriate action to resolve any delay in reimbursement.
Works correspondence daily, including adding Medicaid eligibility to self-pay and commercial accounts.
Works returned mail on high-dollar accounts and correspondences from third-party payors.
Takes appropriate action to resolve all insurance, bad debt, and/or self-pay unpaid balances.
Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.
Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.
The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
- Occasionally (activity or condition exists up to 1/3 of time)
- Not Present
- Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
- Occasionally (activity or condition exists up to 1/3 of time)
- Occasionally (activity or condition exists up to 1/3 of time)
- Frequently (activity or condition exists from 1/3 to 2/3 of time)
- Occasionally (activity or condition exists up to 1/3 of time)
- Occasionally (activity or condition exists up to 1/3 of time)
No potential for exposure to blood and body fluids
Children's Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children's is dedicated to making kids better today and healthier tomorrow.
With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children's is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children's offers access to more than 70 pediatric specialties and programs and is ranked among the top children's hospitals in the country by U.S. News & World Report.
Children's has been ranked on Fortune magazine's list of "100 Best Companies to Work For" for fourteen consecutive years and named one of the "100 Best Companies" by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow.
Have questions about the recruitment process? Check out What to Expect.
Address: 1455 Tullie Circle NE, Atlanta, GA 30329
Function: Revenue Cycle
- Patient Financial Services
Nearest Major Market: Atlanta
Job Segment: Medical, EMR, Pediatric, Medicaid, Healthcare
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