Insurance Follow-Up Representative

Job Description:

Our Westchester, NY-based client seeks two Temp-to-Perm Insurance Follow-Up Representatives.

Temp-to-Perm Insurance Follow-Up Representative Position Summary
Responsible for initiating follow-ups with third-party payers on outstanding accounts, reviewing insurance correspondence, and responding promptly. Responsible for supplying third-party payers with appropriate billing information in order to adjudicate a claim. Responsible for assuring appropriate payment was received in accordance with contract terms, reporting trends, and collaborating with denials and variance teams to ensure prompt and accurate payments. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, and appealing claims when appropriate.

• Temp rate: Pay up to $30
  
• Perm Salary - $53K - $80K.
  
• Monday through Friday. For billing, the client would be open to a Sunday thru Thursday or Tuesday thru Saturday shift.
  
• Hours are flexible, either: 8 am-4 pm, 8:30 am-4:30 pm & 9 am-5 pm.
  
  Essential Functions and Responsibilities Includes the Following:
  1. Understands and adheres to the client’s Performance Standards, Policies, and Behaviors
  2. Completes review of third-party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances
  3. Processes patient and insurance refunds
  4. Review open accounts for reconciliation and the next steps to resolve open balances
  5. Review cases with provider representative liaison to ensure escalation and processing of outstanding balances
  6. Contact payors and patients as needed to resolve open balances and account issues
  7. Responsible for reviewing assigned work queues and ensuring all accounts are worked timely, especially high dollar and aged accounts
  8. Reviews correspondence for appropriate action to resolve accounts
  9. Assure clear and concise notes within the EMR for all transactions
  10. Completes associated actions within the EMR, such as insurance updates, adjustments, and allowances as needed
  11. Escalates issues to management and provider representatives regarding incorrect payer processing, contract issues and/or trends
  12. Communicate with third-party representatives, relaying issues and discussing payment expectations
  13. Take appropriate actions to resolve issues in a way that results in payment and/or complete closure of the insurance balance
  14. Assure payor plan types and policy numbers are updated accurately within the EMR
  15. Collaborates with teammates and vendors as needed to reconcile and resolve outstanding accounts
  16. Review of claims to ensure payers process claims timely and according to contract provisions
  17. Responsible for timely completion of projects and tasks as assigned by management and feedback on outcomes
  18. Responsible for ensuring productivity measures are being met daily
  19. Performs all other related duties as assigned
  

  Requirements:

  Education & Experience Requirements
  · High School Graduate or GED required
  · 2-5 years previous patient accounting and insurance follow-up experience (hospital), preferred
  · Knowledge of medical terminology required
  · Familiarity with electronic medical record system, EPIC preferred
  · Proficiency with Microsoft Office/excel to include PIVOTS and VLOOKUP, intermediate level required
  · Must be detail-oriented, able to problem solve, multi-task, and perform various duties on demand
  · Certified Patient Financial Services Specialist (CPFSS) certificate is required
  · Effective 12/1/2022, the HBI (Healthcare Business Insights) one-time certification course is required and must be completed during the onboarding period and prior to the start date.