About this role
Position Summary
1. Submit third party payer primary, secondary, tertiary and corrected claims utilizing electronic billing software.
2. Reconcile all confirmation reports post-electronic submission from all third party payers. Evaluate and process the needed corrections and revalidate the claim electronically.
3. Analyze and take appropriate action on payer rejections and denials.
4. Aggressively performs follow-up and collections from the third party payers.
5. Verify payments though manage care payer software for accuracy and aggressively pursue collections on underpayments.
6.Negotiates reimbursement rates with non-contracted third party payers and case managers.
7. Stays current on rules and regulations affecting billing, reimbursement and submission of claims.
8. Process correspondence received from third party payers and patients.
9. Performs other related responsibilities as required or requested.
10. Demonstrates service excellence.
Responsibilities
Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
Identify and prioritize high-value or aged claims for immediate follow-up.
Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.
Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.
Document all communication and actions taken on each claim in the billing system.
Update patient accounts with the current status of claims and expected payment dates.
Resubmit corrected claims to insurance companies when errors are identified.
Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.
Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.
Assist patients with calling their insurance plans to resolve claim processing issues.
Document detailed and organized follow-up activities, including communication logs, and claim statuses.
Ensure that documentation is complete and compliant with internal policies and external regulations.
Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.
Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.
Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.
Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.
Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.
Minimum Requirements
Required Education/Course(s)/Training:
High school diploma/equivalent or higher
5 + years of experience in A/R follow-up
Required Certification/Registration: None
Certified Revenue Cycle Representative (CRCR) preferred.
Skill Set Requirement:
Ability to analyze claims, identify issues, and develop solutions.
High level of accuracy and attention to detail in reviewing and following up on claims.
Strong analytical and problem-solving skills to identify and resolve issues related to claims processing.
Excellent verbal and written communication skills for effective interaction with insurance representatives, patients, and internal teams.
Understanding of healthcare billing regulations, HIPAA compliance, and insurance guidelines.
Proficient in payment review systems, hospital information systems and coding methodologies.
Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards
Communicate orally and in written form.
Understand insurance terms and payment methodologies.