Insurance Follow Up Representative
Excel Partners, White Plains, NY, United States
Insurance Follow-Up Representative
Department/Location: Patient Accounts
Reports to: Supervisor, Patient Accounts
Salary Range: $53,840.67-$80,782.07
Remote option available
Position Summary
Responsible for initiating follow-up to third party payers on outstanding accounts and reviewing insurance correspondence and responding in a timely manner. Responsible for supplying third party payers with appropriate billing information in order to adjudicate a claim. Responsible for assuring appropriate payment received in accordance with contract terms, reporting trends and collaborating with denials and variance teams to assure 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.
Essential Functions and Responsibilities
Understands and adheres to the WPH Performance Standards, Policies and Behaviors
Completes review of third-party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances
Processes patient and insurance refunds
Reviews open accounts for reconciliation and next steps to resolve open balances
Reviews cases with provider representative liaison to assure escalation and processing of outstanding balances
Contacts payors and patients as needed to resolve open balances and account issues
Responsible to review assigned work queues and assure all accounts are worked timely, especially high dollar and aged accounts
Reviews correspondence for appropriate action to resolve accounts
Assures clear and concise notes within the EMR for all transactions
Completes associated actions within the EMR such as insurance updates, adjustments, and allowances as needed
Escalates issues to management and provider representatives regarding incorrect payer processing, contract issues, and/or trends
Communicates with third-party representatives relaying issues and discussing payment expectations
Takes appropriate actions to resolve issues in a way that results in payment and/or complete closure of insurance balance
Assures payor plan types and policy numbers are updated accurately within the EMR
Collaborates with teammates and vendors as needed to reconcile and resolve outstanding accounts
Reviews claims to assure payers process claims timely and according to contract provisions
Responsible for timely completion of projects and tasks as assigned by management and provides feedback on outcomes
Responsible to assure productivity measures are being met daily
HBI certification required
Performs all other related duties as assigned
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 PivotTables 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 required
Core Competencies
Teamwork, communication skills, problem solving, and adaptability
Must be able to speak, write, understand, and communicate in the English language; effectively communicate with internal and external customers
Retains composure under stress
Integrity to handle the confidential aspects of work
Physical/Mental Demands/Requirements & Work Environment
May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) database and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.
Must be able to remain in a stationary position at least 50% of the time
The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer
The person in this position will need to communicate with insurance plans and patients that may have questions and must be able to accurately exchange information in these situations.
IND2
Department/Location: Patient Accounts
Reports to: Supervisor, Patient Accounts
Salary Range: $53,840.67-$80,782.07
Remote option available
Position Summary
Responsible for initiating follow-up to third party payers on outstanding accounts and reviewing insurance correspondence and responding in a timely manner. Responsible for supplying third party payers with appropriate billing information in order to adjudicate a claim. Responsible for assuring appropriate payment received in accordance with contract terms, reporting trends and collaborating with denials and variance teams to assure 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.
Essential Functions and Responsibilities
Understands and adheres to the WPH Performance Standards, Policies and Behaviors
Completes review of third-party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances
Processes patient and insurance refunds
Reviews open accounts for reconciliation and next steps to resolve open balances
Reviews cases with provider representative liaison to assure escalation and processing of outstanding balances
Contacts payors and patients as needed to resolve open balances and account issues
Responsible to review assigned work queues and assure all accounts are worked timely, especially high dollar and aged accounts
Reviews correspondence for appropriate action to resolve accounts
Assures clear and concise notes within the EMR for all transactions
Completes associated actions within the EMR such as insurance updates, adjustments, and allowances as needed
Escalates issues to management and provider representatives regarding incorrect payer processing, contract issues, and/or trends
Communicates with third-party representatives relaying issues and discussing payment expectations
Takes appropriate actions to resolve issues in a way that results in payment and/or complete closure of insurance balance
Assures payor plan types and policy numbers are updated accurately within the EMR
Collaborates with teammates and vendors as needed to reconcile and resolve outstanding accounts
Reviews claims to assure payers process claims timely and according to contract provisions
Responsible for timely completion of projects and tasks as assigned by management and provides feedback on outcomes
Responsible to assure productivity measures are being met daily
HBI certification required
Performs all other related duties as assigned
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 PivotTables 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 required
Core Competencies
Teamwork, communication skills, problem solving, and adaptability
Must be able to speak, write, understand, and communicate in the English language; effectively communicate with internal and external customers
Retains composure under stress
Integrity to handle the confidential aspects of work
Physical/Mental Demands/Requirements & Work Environment
May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) database and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.
Must be able to remain in a stationary position at least 50% of the time
The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer
The person in this position will need to communicate with insurance plans and patients that may have questions and must be able to accurately exchange information in these situations.
IND2