Representative, Insurance Services – Insurance Follow Up

Description
Job Title:  Representative, Insurance Services – Insurance Follow Up

Company:  Acclara

Department:  Insurance Services

Leader:   Supervisor, Insurance Services

FLSA Status:  Hourly/Non-Exempt

Work Location: Remote; located within the U.S.

Travel:  No travel required

Compensation:  $15.00 – $26.46

OVERVIEW

The Representative, Insurance Services position is responsible for all insurance follow up on assigned accounts (including on pre-determined balance thresholds). Core responsibilities include research, insurance billing and adjustment identification to ensure proper account resolution to optimize cash flow and reduce bad debt for our Acclara clients. The Representative, Insurance Services will also assist with new hire and team member training/mentoring.

Responsibilities include:

Works accounts from assigned area(s) to maximize reimbursement
Ability to resolve payer rejections and denials through the appeals process as required by each payers contracting agreements
Performs systematic, consistent, and timely follow-up. Taking appropriate action to process accounts to resolution
Responsible for working payer correspondence, edits, and aged accounts receivable, identifying, and correcting billing errors
Resolves unpaid/under-paid claims and collections on behalf of clients
Obtain claim status via various methods (telephone, internet, fax)
Review and interpret contractual terms for managed care, commercial, Medicare, Medicaid and/or worker’s compensation
Contacts various payers and patient to collect outstanding accounts. Tracks and enters all calls for documentation, trending, and reporting
Identifies contractual and administrative adjustments
May perform billing functions via electronic and hardcopy submission
Ascertains account information and corrects charge and claim discrepancies. Makes necessary corrections regarding insurance data or patient’s registration
Obtains supporting documentation regarding insurance follow-up efforts
Corrects clearinghouse and payer rejections daily, notifying management of trends
Obtain pre-certifications and TARS as required by policy
Review and responds to insurance/patient correspondence timely
Identifies billing issues and trends and reports to management any concern or discrepancies in a timely manner
May compose correspondence including claim forms, appeals, and notification to applicable parties
Contact and educate patients and guarantors regarding necessary steps to resolve an outstanding insurance balance while providing exemplary customer service
Maintains ongoing knowledge of third-party billing requirements. Understands billing timeliness and urgency in meeting all claim and filing deadlines.
Keeps current with knowledge of professional payer contracting agreements
Audits and reviews daily tasks to ensure accuracy and completeness prior to end of work shift. Balances and closes batches in a timely manner.
Ability to identify recurring trends, complicated payer issues/disputes and procedural deficiencies and report them to management with recommended resolution
Regularly exceeds productivity and quality metrics
Ability and willingness to float to other departments as needed
May act as backup for Lead, Insurance Services
Assists with new hire and team member training/mentoring
Assist with special projects
Other duties as assigned

QUALIFICATIONS FOR REPRESENTATIVE, INSURANCE SERVICES

High school diploma or GED
3 or more years high volume, multi-disciplined experience in billing, insurance collections/follow-up and denials/appeals
Working knowledge of insurance; PPO, EPO, HMO, Medicare, Medicaid, Worker’s Compensation.
Knowledge of computerized registration, billing, collection, and problem resolution procedures
Electronic health record experience (Epic, Cerner, Meditech etc.)
Ability to work independently and meet set production and quality goals
Familiarity with medical terminology, coding (CPT/ICD-10/HCFA, UB04, HCPCS, DRG and authorizations/referrals
Excellent customers service, communication (written and verbal), interpersonal and organizational skills
Ability to navigate health plan websites to verify eligibility, benefits and claim status
Must be able to work in a fast-paced department and handle multiple tasks, work with interruptions, and deal effectively with confidential information

Preferred Qualifications for Representative, Insurance Services

Previous experience with numerous payer systems
Previous experience in medical billing
Certified Professional Coder (CPC) or Certified Professional Biller (CPB) certifications by the AAPC

Physical Requirements:

The physical demands described 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.  Listed below are the physical requirements required while performing the duties of this job.

The employee is regularly required to: stand; sit; talk; hear; use hands and fingers to operate a computer and telephone keyboard; and reach, stoop and/or kneel to install computer equipment
The employee must have the specific vision ability to complete close vision requirements due to computer work
The employee is required to be able to complete light to moderate lifting