Job Description
Summary/Objective
Under limited supervision the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in filing insurance claims, determining correct reimbursements/ adjustment/write-offs, and denial management. They also analyze plans to determine which benefits are covered, submit secondary insurance claims, generate patient statements, and follow-up on those submissions.
Essential Job Functions
- Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
- Analyze claims (denial/non-denial) in practice management systems, internal system and direct toward resolution (Payment, Adjustment & self-pay).
- Technical billing and denial follow-up on all assigned payer claims
- Call Payer (Insurance/ third parties) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay).
- Identify potential process improvements, trends, issues and escalate to Supervisor.
- Be part of initial and all ongoing training session to enhance knowledge of RCM processes.
- Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account transactions.
- Identify trends/payer issues and escalate complex payer issues to the lead billing specialist, as necessary.
- Maintain a working knowledge of client policies and procedures. Follow the Workflow documentation like SOP’s Update tracker, Issue Log and Trend logs.
- Maintain quality standards as determined by management.
- Assist the Manager or Team Lead in working priority reports promptly, effectively, and efficiently.
- Maintain accurate records within a collections database.
- Be a mentor to new employees and assist in their training and development.
- Performs other duties as directed.
- Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.
Key Success Indicators/Attributes
- Ability to prioritize and multi-task in a fast-paced, changing environment.
- Demonstrate ability to work in all work types and specialties.
- Demonstrate ability to self-motivate, set goals, and meet deadlines.
- Demonstrate leadership, mentoring, and interpersonal skills.
- Demonstrate excellent presentation, verbal and written communication skills.
- Ability to develop and maintain relationships with key business partners by building personal credibility and trust.
- Maintain courteous and professional working relationships with employees at all levels of the organization.
- Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.
- Demonstrate excellent analytical, critical thinking and problem-solving skills.
- Manage the Individual KRA’s as per the provided metrics.
- Understand client requirements and specifications of the project & Ensure targeted collections are met on a daily / monthly basis.
- Meet the productivity targets of clients within the stipulated time. Ensure timely follow up on pending claims and to prepare and Maintain individual status reports.
- Skill in operating a personal computer and utilizing a variety of software applications is essential.
- Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes is an added advantage.
- Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage.
Supervisory Responsibility
No
Work Environment
This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones.
Physical 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.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.
Position Type/Expected Hours of Work
This is a full-time position. Schedule is M-F 8am-4pm EST without a lunch, with a lunch it is M-F 8am-430pm EST. This position occasionally requires long hours and weekend work.
Travel
Minimal travel required; up to 5%
Required Education and Experience
Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing. Minimum 1-2 years’ experience in Medical Billing/Coding and experience with standard office software products. High School diploma or equivalent.
Preferred Education and Experience
N/A
Additional Eligibility Qualifications
N/A
Security Access Requirements
In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega set forth in the “Omega Field Employee” profile.
