Insurance Follow-up Specialist

General Summary

The Insurance Follow-up Specialist is responsible for timely, efficient and accurate follow-up on outstanding insurance and credit balances. This role also handles reworks, re-submissions, reconsiderations, appeals, and claim communications, ensuring compliance with payer requirements.

Principal Job Functions

• Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• Performs follow-up on all outstanding claims and takes the appropriate action to ensure timely and accurate reimbursement following the payers' filing guidelines.
• Reviews and analyzes all claims for correct and complete patient and insurance information, service dates, and charges.
• Makes outbound calls to payers and accesses payer websites.
• Maintains knowledge of current billing guidelines and third-party payer regulations.
• Investigates reason for errors by communicating with specified department personnel and makes the necessary corrections within the system.
• Actively researches State and Federal regulations and billing guidelines to stay current to ensure compliance.
• Contacts patients or employers as necessary for correct health plan information by calling or sending correspondence as needed.
• Responds to all inquiries, billing rejections, and other correspondence and phone requests in an efficient and effective manner.
• Completes reconsiderations and appeals as needed. Works with the appropriated department concerning any coding issues or reviews. Follows Medical Center protocols in communicating and releasing patient information.
• Documents all activities on accounts in the hospital patient accounting system. Identifies issues or trends with accounts and makes suggestions for possible resolutions.
• Works closely with the Hospital Billing Specialists to resubmit claims and resolve errors as needed.
• Performs other related projects and duties as assigned.

Required Knowledge, Skills And Abilities

• Knowledge of patient accounting operations and standard techniques.
• Knowledge of credit and collection practices, third-party payer regulations and Joint Commission regulations.
• Knowledge of federal, state and facility regulations including COBRA, HIPPA, Medicare, Medicaid and Corporate Compliance Plan.
• Knowledge of billing and third-party reimbursement websites for resource support and claim status updates.
• Knowledge of computer hardware equipment and software applications relevant to work functions.
• Knowledge of CPT and ICD-10 codes.
• Ability to meet minimum productivity standards set forth by the department.
• Ability to communicate effectively both verbally and in writing.
• Ability to prioritize work demands and work with minimal supervision.
• Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, volunteer and ancillary departments.
• Ability to maintain confidentiality relevant to sensitive information.
• Knowledge of the Centers for Medicare and Medicaid Services (CMS), to include CCI, MUE, and OCE editing practices as they relate to government claims.
• Strong analytical, problem-solving, and communication skills.
• Advance work knowledge by participating in continuing education in-services, webinars, teleconferences, reading periodicals/literature and seeking ongoing development opportunities.
• Ability to react and effectively perform work under stressful situations.
• Ability to maintain regular and punctual attendance.

Education And Experience

• A high school diploma or equivalency required.
• An associates degree in business or accounting related field preferred.
• One (1) year of experience in a healthcare setting, preferably working in billing, insurance follow-up or accounting required.
• Training or prior experience in CPT/ICD-10 coding desired.
• Must be at least 19 years of age to witness legal consents.