The Account Follow-up Representative II is responsible for the review and resolution of outstanding insurance balances on hospital patient accounts. The Account Follow-up Representative II is required to learn multiple hospital systems, conduct research analysis, utilize intermediate skills to work basic to complex outstanding insurance claims, work closely with third party payors to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims.
Primary Duties:
Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution
Work an average of 40-50 accounts per workday for assigned payor(s)
Assigned Payor denials and Zero ($0) pay reports worked within 24 hours of receipt
Gather additional demographic, clinical information, medical records, authorizations, and insurance related information deemed necessary to pay outstanding medical claims and update the applicable systems with the patient’s information
Ability to prioritize job responsibilities and manage time effectively for completion of assignments
Analyze, communicate, and participate in resolving denial/variance trends and payor issues with other teams/departments within the organization
Identifies and prepares less complex claims for reconsiderations and appeals
Assists leadership in managing assigned A/R and ensure resolution of outstanding insurance balances at 90 days post discharge
Works closely with third party payors and takes next steps to reach resolution of outstanding insurance balances.
Must have the ability to deliver education and training for new hires along with assisting less experienced representatives.
Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows
Review and recommend adjustments to accounts in accordance with payor, company, and client guidelines
Participate and complete projects assigned by team lead or manager to fulfill clients’ contractual agreement of services
Work in partnership with other teams/departments regarding resolution of project issues, concerns, and workflows
Complete assigned LinkedIn learning path within the calendar year
Attend role-based education courses within the calendar year
Assists leadership with special projects and/or stretch assignments
Other duties as assigned
Administrative Duties:
Accurately input/submit worked time by the required departmental deadlines
Maintain knowledge of insurance payors and collection regulations
Maintain industry knowledge through self-study and by attending training classes
Attend and participate in team and departmental meetings
Effectively responds to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from patients, agencies, and facilities in a timely manner
Adherence to all HIPAA Privacy and Security requirements and responsibilities
Perform duties and responsibilities in a positive manner that upholds company policies and procedures
Other Skills:
Knowledge of revenue cycle processes impacting insurance reimbursements
Knowledge of the insurance follow-up processes with understanding of the fundamental concepts in healthcare reimbursement methodologies
Solid understanding of Institutional (UB04) and Professional (1500) claim forms required
Use critical thinking skills and payor knowledge to recommend system edits/updates to reduce denials and result in prompt and accurate payment
Proficiency with telephone systems for outbound/inbound calls
Access protected health information (PHI) in accordance with departmental assignments and guidelines
Skilled in making accurate arithmetic computations
Excellent communication, good judgment, tact, initiative, and resourcefulness
Must be detail oriented, organized, and ability to multi-task
Possess ability to concentrate for long periods of time
Ability to work individually and/or as part of a team
Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives
Must be flexible with a “can do” attitude and the ability to remain professional under high pressure situations
Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe
Understand both oral and written directives
Training and Experience:
High School or equivalency diploma required
0-3 years’ experience in related field (recent graduate of Medical Billing and Coding coursework accepted in lieu of experience)
Must be able to follow directions and to perform work according to department standards independently
Must be emotionally mature and able to function effectively under high pressure situations
Sufficient in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned
Customer Service oriented
Other Requirements:
High Speed Internet access and unlimited data
Smart phone for DUO authentication
Negative pre-employment drug tests
Criminal and MVR backgrounds meet our company hiring criteria