Revenue Cycle AR Representative - ONSITE REQUIRED
27 days ago
Munster
Job Description Job Summary The Insurance Follow-Up Representative reviews and researches unpaid claims in accordance with contracts and policies in order to achieve maximum reimbursement. The core responsibilities will include: identifying unpaid claims through reports and dashboards; reviewing submitted claims for complete information, correcting and completing claims and/or forms as needed; addressing denial letters and insurance medical records requests needed for claims processing; and resubmitting claims returned to provider/subscriber if additional information in needed. Additional follow-up responsibilities include: direct follow up with patient when required; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general patient phone inquiries including patient payments, then recording the results in the practice management system. Qualifications: • High school diploma or an equivalent combination of education and experience., • Associate degree or higher in coding or health information management, accounting or business administration highly desired., • Data entry skills (50-60 keystrokes per minute), • Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing medical claims processing, patient financial counseling, coding and/or claims follow up is required, • Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc), managed care contracts and coordination of benefits is required., • Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are required., • Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers., • Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions., • Performs all follow-up functions, including the investigation of underpayments, payment delays resulting from denied, rejected and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner. These functions will be in coordination with the Business Office team., • Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Billing Manager:, • Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions;, • Proactively follows-up on delayed payments by contacting patients and 3rd party payers, and supplying additional data, as required;, • May perform financial counseling activities, including but not limited to: discussing balances with patients, setting up payment plans, explaining statements and insurance processing. Counsels patient/guarantor on patient's financial liability, third party payer requirements ., • Counsels patient/guarantor of payment plan options and establishes appropriate plan;, • Investigates No Fault and Workers' Compensation cases, retrieving police report and insurance information, as required;, • Determines and manages proper course of action for optimal reimbursement of healthcare charges, • Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect; and, • Updates and refiles claim forms in a timely, accurate manner., • Responds to patient and 3rd party payer inquiries (telephone, fax, mail and web-based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution., • Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management, Managed Care, Ancillary and Nursing staff, as required to clarify billing discrepancies, and obtain demographic, clinical, financial and insurance information., • May prepare special reports as directed by the Manager to document billing and follow-up services (e.g., Number of claims and dollars billed, number of claims edited, number of claims unprocessed, etc.)., • May serve as relief support, if the work schedule or workload demands assistance to departmental personnel., • May also be chosen to serve as a resource to train new employees., • Cross- training in various functions is expected to assist in the smooth delivery of departmental services., • Maintains a working knowledge of applicable Federal, State, and local laws and regulations, as well as OSNI’s Standards of Conduct, and other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior., • Other duties as needed and assigned by Billing Manager, Practice Manager, and/or CEO Physical Requirements: • Ability to fulfill any office activities normally expected in an office setting, to include, but not limited to: remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.), • Fine hand manipulation (keyboarding), • Must be able to set and organize own work priorities, and adapt to them as they change frequently., • Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles., • Excellent problem solving skills are essential., • Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.