Insurance Follow-Up Rep

• Reviews insurance denials and rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding denials/rejections.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Verifies receipt of claim with insurance plans, determining the next appropriate action steps and timeliness of claims maximum reimbursement.
• Researches all information needed to complete billing process including obtaining information from providers, ancillary services staff, and patients.
• Obtains and attaches referrals/authorizations to appointments/charges.
• Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards.
• Assumes full responsibility of reducing the accounts receivable of insurance balances by working through outstanding accounts.
• Analyzes accounts for proper claims processing and payment posting through inquiries from patients or staff.
• Identifies and communicates trends and/or potential issues to management team.
• Follows and maintains all HOPCo policies and procedures, including those specific to billing and the Revenue Cycle.
• The job holder must demonstrate current competencies for job position.

EDUCATION

• High school diploma or GED

EXPERIENCE

• Minimum two to three years of experience in medical billing. Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.

REQUIREMENTS

• None

KNOWLEDGE

• Knowledge of the physician billing processes, ICD-10 and CPT coding.
• Knowledge of computer systems. Experience with Athena preferred.
• Knowledge of insurance plan websites and portals.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skill in customer service
• Skill in using computer programs and applications including Microsoft Excel, Microsoft Word and Outlook.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.