Job Description

We are seeking Insurance Follow-up Specialists to become a part of our organization! You will investigate and analyze various claims.

QUALIFICATIONS:

• Previous experience in insurance follow-up
• Experience in conflict resolution
• Excellent written and verbal communication skills
• Deadline and detail-oriented

JOB FUNCTIONS:

Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.

• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
• Assists with unusual, complex or escalated issues as necessary.
• Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
• Accurately documents patient accounts of all actions taken in billing system.
• IDENTIFIES POTENTIAL TRENDS IN DENIALS/REIMBURSEMENT BY PAYER OR BY TYPE, DENIAL REASON, OR CODING ISSUE AND REPORTS TO SUPERVISORY STAFF FOR APPROPRIATE ESCALATION.
• Uses critical thinking skills and payer knowledge to recommend system edits to reduce denials and result in prompt and accurate payment.
• Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
• Communicates with supervisor and staff regarding insurance carrier contractual and regulatory requirements that impact payment and denials.
• DOCUMENTS ALL ACTIVITIES AND FINDINGS IN ACCORDANCE WITH ESTABLISHED POLICIES AND PROCEDURES; ENSURES THE INTEGRITY OF ALL ACCOUNT DOCUMENTATION; MAINTAINS CONFIDENTIALITY OF MEDICAL RECORDS.
• Meets quality assurance and productivity standards for timely and accurate denial resolution in accordance with organizational policies and procedures.
• MAINTAINS CURRENT KNOWLEDGE OF INTERNAL, INDUSTRY, AND GOVERNMENT REGULATIONS AS APPLICABLE TO ASSIGNED FUNCTION.
• Understands detailed billing requirements, denial reason codes, and insurance follow-up practices.
• Understands government and commercial insurance reimbursement terms, contract language, and appropriate reimbursement amounts.
• Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc.

Company Description

MPS is a specialized personnel agency focused on serving the physicians of our community by providing the most qualified candidates for their practices, making their practices run more smoothly and allowing them to take better care of their patients. MPS is a subsidiary of the Chattanooga-Hamilton Medical Society which is physician owned and driven.