Denials & Follow-up Rep- Professional Partnerships- Remote

About the Role

This position is primarily responsible for resolving all outstanding insurance account receivables. Responsibilities include performing collection and billing activities related to account resolution, and communicating with payors (Government and Commercial), clients, reimbursement vendors, and other external resources such as patients.

Responsibilities

• Performs account research with internal and/or external resources via phone and payor websites to determine status of the account with the expected result of obtaining payment of the account.
• Verifies and/or updates insurance and demographic information for accuracy to resolve barriers in receiving payment of the account.
• Follows-up with payors and checks claim status as needed throughout the payment process.
• Appeal denials when needed throughout the payment process and determines when appeals should be sent for further research and/or review.
• Maintains knowledge of differing payor guidelines to ensure accurate reimbursement by various resources, such as department meetings and updates on payor websites.
• Identifies trends that may cause or are causing various types of issues on assigned accounts and reports to leader with recommendations for system improvements/edits.
• Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance.
• Other related duties as required.

Requirements

• High School diploma or equivalent (required).
• Associates Degree or Bachelor Degree (preferred).
• 1 year related experience in hospital, clinic, medical office, business services/revenue cycle, front line registration, financial counseling, banking, and/or customer service (required).
• Prior experience working with EPIC System (preferred).

Skills

• Computer skills and dexterity required for data entry and retrieval of required job information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals.
• Proficient with Windows-style applications, keyboard, and various software packages specific to role.
• Strong interpersonal skills.
• Ability to multi-task.
• Ability to perform effectively in a fast-paced, ever-changing environment.
• Ability to remain calm and professional in high-pressure/stressful situations regarding patient financial and medical conversations.
• Reliable transportation to travel to other facilities to fill in as needed.

Physical and Environmental Demands

The physical demands described here 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.

• Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
• Normal routine involves no exposure to blood, body fluid, or tissue, and incumbents are not called upon to perform or assist in emergency care or first aid.
• The incumbent has no occupational risk for exposure to communicable diseases.
• There may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning, and/or disposal of contaminated waste.