Claims Follow Up Rep TC

About the role

Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers, taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence, as well as demonstrate core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

Responsibilities

• Review claim forms for all required data fields depending on the specific 3rd party requirements.
• Review patient accounts for demographic accuracy.
• Process system adjustments or changes such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and other routine patient accounting adjustments.
• Analyze assigned claims to ensure accurate and timely reimbursement based on individual payer’s contracts or Federal reimbursement methods.
• Contact insurers via online systems, call centers, written correspondence, fax, or appropriate electronic or paper billing to secure payment.
• Maintain an understanding of current contract language to ensure reimbursement in accordance with contract terms.
• Stay updated on payer-specific changes via listservs, provider updates, webinars, meetings, and websites.
• Review payer settlements for correct reimbursement and contact insurers if claims are not adjudicated correctly.
• Identify and analyze denials and payment variances, enacting corrective measures to resolve payer errors.
• Maintain compliance with HIPAA guidelines when handling patient information.
• Initiate adjustments to payers for under or over payments based on contract, Federal regulation, late charge corrections, or inappropriate denials.
• Submit appeals to payers to recover denied revenue.
• Contact internal departments to acquire missing or erroneous information delaying claim adjudication.
• Run reports to quantify variances on patient accounts related to payer issues or charging errors.
• Report trends resulting in under/over payments, inappropriate denials, or billing discrepancies to the supervisor.
• Answer telephone inquiries from 3rd parties and interdepartmental calls; refer unusual requests to supervisor.
• Retrieve medical records documentation based on third-party requests.
• Process secondary and tertiary claims accurately and timely according to specific 3rd party regulations.
• Process incoming mail and follow up on rejections according to specific 3rd party regulations.
• Refer unresolved accounts to supervisor for additional review.
• Collaborate with supervisor, management, and staff to improve processes, increase accuracy, and create efficiencies.
• Maintain quality assurance, safety, environmental, and infection control standards.
• Perform other related duties as required.

Work Location & Expectations

After orientation at the Corporate facilities, work may be performed based on the following options approved by management, with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy:

• Full-time schedule worked in office.
• Full-time schedule worked in a dedicated space at home.
• Part-time schedule split between office and a dedicated home space.

Schedules must be approved in advance by management. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with their supervisor as directed.

Requirements

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing, including ICD, CPT, HCPCS, UB, and HCFA 1505 claim forms.
• Demonstrated skills in critical thinking, diplomacy, and relationship-building.
• Highly developed communication skills for working with a wide variety of people in individual and team settings.
• Demonstrated problem-solving and inductive reasoning skills.
• One to three years of relevant experience in medical collections or professional/hospital billing preferred.

Incumbent generally establishes their own work plan based on pre-determined priorities and standard procedures. Problems needing clarification are reviewed with the supervisor prior to taking action.

Pay

$19.97 - $32.96 per hour.

Schedule

Monday–Friday, 8:00 AM – 4:30 PM (8 hours per day).