Remote Experienced Insurance Follow-Up Representation

The position is available for remote work at the following states:   Florida, Tennessee, Texas, Wyoming
Campbellsville, KY and Louisville, KY- (Must be located within 30 miles)
South Carolina (Must be located within 30 miles of Aiken, South Carolina)

Work Hours:  7:00AM - 4:00PM CST / 8:00AM - 5:00PM EST  Monday – Friday 
**Scheduled Hours are dependent upon client needs and established schedules can be
adjusted at any time to meet the needs of the department to ensure business continuity.**

POSITION SUMMARY

The Insurance Billing & Follow-Up Representative ensures the efficient handling of all insurance billing, follow-up and collection activities.  Communicates with insurance companies and state agencies.  Completes reconciliation and billing of accounts making independent decisions based on payer, coding and billing guidelines.  This is done by reviewing, researching, and processing claims in accordance with contracts and policies to determine the extent of liability, as well as to adjudicate claims as appropriate.  The actual work performed will depend on client needs and current active projects (projects could be long-term or short-term). This position requires knowledge of the UB04 and HCFA claim billing forms, timely filing limits set forth by various payers, various payor portals for follow-up and research, and general billing policies and guidelines. This position requires the ability to work independently, meet daily productivity and quality goals, provide excellent customer service and communication skills, creativity, patience, and flexibility. The Insurance Billing & Follow-Up Representative relies on guidelines established by the organization to perform job functions and works under general supervision in a fast-paced environment.

PRIMARY RESPONSIBILITIES

• Monitor, research, and resolve no response, denied, and underpaid medical claims on Medicare and Managed Medicare, Medicaid and Managed Medicaid, Government, Commercial, MVA, Workers’ Compensation, and other Third-Party Liability payers.
• Research claim rejections, make corrections, take corrective actions, and/or refer claims to appropriate colleagues to ensure timely and accurate claim resolution.
• Proactively follow-up on delayed payments by contacting patients and third-party payers determining the cause of delay and supplying additional data as required.
• Research and resolve insurance payment recoupments and credit balances for all payer types.
• Collaborate with both internal and client departments to verify and validate billing information and coding changes.
• Partner with clients and patients to obtain additional information that aids in resolving outstanding medical claims.
• Communicate with insurance companies to effectively resolve denied and underpaid claim's persistent in your disputes with insurance companies regarding denied claims.
• Perform accurate follow-up activities and appeal within the appropriate time frame.
• Submit or Re-Submit claims and medical documentation.
• File payer reconsiderations and/or formal appeals as needed.
• Denial root cause identification and tracking of denial trends by payer, location, and service billed.
• Exhibits effective ability and accurate documentation of your claim research, resolution activity, and the next step required for each account worked.
• Ability to work in multiple EMR and billing systems, adapting easily to changes in client guidelines and billing/payer system's daily productivity and quality performance metrics established by management.
• Utilize department, payer, and client resources, as well as perform independent research, to achieve completion of tasks and reduce reliance on supervisory oversight.
• Identifies and escalate issues affecting accurate billing and follow-up activities.
• Effectively acts as a resource to peers and assists others in growth and development of insurance follow-up related skills
• On a quarterly basis, exceeds expectations in productivity and quality performance metrics established by management.
• Performs other duties as assigned.

• Minimum High School diploma or equivalent required.
• Minimum 3-5 years of experience in denial management and insurance follow-up is required.
• Experience in medical billing, loading and verifying insurance in the correct filing order, and medical billing customer service and collections is desirable.
• Experience working directly with EOBs, contractual adjustments, and denial remittances is required.
• A working knowledge of medical and insurance terminology is required. 
• Knowledge of healthcare/insurance practices and processes.
• Knowledge of federal, state, and local laws, regulations, and rules concerning the insurance industry.
• A track -record of strong knowledge in billing, claim denial management and insurance follow-up protocols, processes, and best practices.

• Prior PC, keyboard, and general computer skills are a mandatory requirement.
• Must have working knowledge in a Windows-based system: word, email, and excel would be beneficial.
• Ability to compute basic math calculations using percentages, addition, subtraction, multiplication, division in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to utilize and research existing department, client, and payer resource documentation to answer or clarify questions, as well as organize and optimize training notes, guidelines, and best practices / action steps needed when resolving denials.
• Perform daily activities as part of the billing and follow-up team in support of the revenue cycle process for our clients.
• Ability to adapt and multi-task and work in a high-volume, time-sensitive environment. 
• Self-motivated and able to work independently to complete tasks and respond to department requests.
• Ability to listen and understand directions and maintain consistent focus on details.
• The ability to retain knowledge from previous job-based training and experience and the ability to comprehend and retain and demonstrate proficiency in new position training and procedures.
• A positive attitude and ability to work within a team environment and individually.
• Ability to understand and demonstrate the Frost-Arnett Mission, Vision, and Values in daily behaviors, practices, and decisions

• Ability to converse and respond to common inquiries from management and all other internal customers.
• Ability to communicate concisely, and effectively, both verbally and written, utilizing proper grammar and telephone etiquette to insurance companies, internal staff, and the public.
• Ability to use interpersonal skills to handle sensitive and confidential situations.
• Ability to write business-related documents such as letters, emails, and other business correspondence as needed.

• Ability to define problems, collect data, establish facts, draw valid conclusions, and create solutions. 

• Market competitive compensation program.
• Health, Gym discounts, Dental, Vision, Life, Health Savings Account, Flexible Spending Account, 401(k), Paid Time Off, Paid Holidays, & More.