Insurance Follow Up Rep - job 3 of 4

Overview

CHI Health strives to care for you the way you care for your patients. 

We understand you have personal responsibilities outside of your profession and also care about your well-being. 

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance 
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO) 
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Responsibilities

The Insurance Follow Up Rep is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements.  An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently.  Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Resubmits claims with necessary information when requested through paper or electronic methods.   
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify. 
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
• Assists with unusual, complex or escalated issues as necessary.
• Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
• Accurately documents patient accounts of all actions taken in billing system.
• Other duties as assigned by leader and organization.

Qualifications

Required Minimum Knowledge, Skills and Abilities

• Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
• Knowledge of medical insurance, payer contract, CPT and ICD codes.
• Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
• Knowledge of the operation and application of automated systems applicable to the assigned function.
• Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
• Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
• Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
• Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
• Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
• Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
• Ability to effectively prioritize and execute tasks while under pressure.
• Ability to demonstrate excellent customer service skills, including professional telephone interactions.
• Ability to read, understand and communicate in English sufficient to perform the duties of the position.
• Ability to establish and maintain effective working relationships as required by the duties of the position.

Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.

PREFERRED Qualifications

High School Diploma or equivalent preferred

Graduation from a post-high school program in medical billing or other business related field is preferred

Two years of revenue cycle or related work experience preferred