Payment Variance Follow Up Representative - Fully Remote

Job Purpose

The Payment Variance Follow Up Representative is responsible for collecting outstanding insurance reimbursement due to contractual discrepancies.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.  
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Detailed knowledge of Managed Care reimbursement methodologies
• Perform payment variance analysis to identify trends in underpaid claims
• Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
• Identify and report underpayments and denial trends
• Initiate appeals when necessary
• Basic knowledge of healthcare claims processing including: ICD-9, CPT, and HCPC codes, as well as UB-04
• Ability to analyze, identify and resolve issues causing payer payment delays 
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
• Maintain confidentiality at all times
• Maintain a professional attitude
• Understand and comply with Information Security and HIPAA policies and procedures at all times 
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
• Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion

Qualifications

• High School Diploma or equivalent required 
• 3 years’ experience in Commercial insurance collections, including submitting and following up on claims
• Experience in Hospital/Facility billing
• Ability to work well individually and in a team environment.
• Proficiency with MS Office
• Strong communication skills/oral and written
• Strong organizational skills

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. 
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.