Claim Follow Up Specialist

Overview

JOB SUMMARY: 

Under the leadership of Patient Financial Services (PFS) management, monitors insurance claims by working the work queues and contacting insurance companies to resolve insurance claims that are not paid in a timely manner. Performs specialized duties for the team and assists the Assistant Manager and Manger with daily activities. Maintains a thorough knowledge of tasks performed in the department in order to fulfill the tasks of the other team members in their absence. 

EDUCATION/EXPERIENCE: 

High school diploma or GED equivalent required. Medical terminology, knowledge of insurance and reimbursement procedures preferred. Business courses such as medical terminology, accounting, finance, cash applications, typing, and word processing preferred. One-year Business Office experience in a healthcare environment, preferred. Hospital or Physician practice billing experience is preferred. Excellent phone etiquette and internal/external customer service skills required. 

ESSENTIAL FUNCTIONS: 

1. Provides direction to the other members of the team, serves as a resource for questions. 

2. Performs collections activity based on collection queue/production goals. 

3. Performs all required FDCPA regulations and system procedures. 

4. Maintains a working knowledge of client policies and procedures. 

5. Maintains acceptable call quality as determined by Management staff. 

6. Assists supervisor in working priority reports promptly, effectively, and efficiently. 

7. Closes out an appropriate number of accounts each month as determined by Management. 

8. Updates the patient account record to identify actions taken on the accounts 

9. Sorts and files correspondence. 

10. Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations. 

11. Demonstrates knowledge and understanding of organizational policies, procedures and systems. 

12. Exhibits knowledge of payer contracts. 

13. Assists in the development of training materials. 

14. Other duties as assigned. 

SKILLS/QUALIFICATIONS: 

Able to work effectively with other employees, patients, and external parties Must be able to type, follow directions and complete assignments within given deadlines Ability to establish priorities Demonstrates proficiency in PC applications required Ability to perform basic math calculations, balance/reconcile figures Ability to punctuate properly, spell correctly and transcribe accurately Demonstrates knowledge of insurance regulations, payment guidelines and policies Ability to communicate and work with payers to get accounts resolved and paid accurately Exhibits extensive knowledge of Medicare and Medicaid regulations Knowledge of Third Party claim filing, contract reimbursement and other insurance guidelines 

WORK ENVIRONMENT: 

Clean, comfortable, office environment Contact may involve dealing with angry or upset people Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergencies Ability to manage exposure to potentially infectious material per OSHA guidelines