Receivable Solutions Inc. is looking for a dynamic Insurance Claim Follow-up Specialist to join our team as an onsite rep at a hospital in Carrollton, GA.

The Insurance Claims Follow-Up Specialist position works in two facets. The individual is an extension of our clients' business offices handling all accounts in accordance with departmental and institutional policies and procedures. The Specialist reviews and ensures the validity of incoming data, correcting information as needed and processes the account for payment. Ensuring accounts are documented, answers inquiries involving individual accounts and researches problem accounts to ensure accuracy for payment. Additionally, the individual follows-up on denied insurance claims with insurance companies and follows-up accordingly to work to resolve claim for payment.

JOB RESPONSIBILITIES:

Follow-Up with Insurance Carriers to determine reason for claims denial and work to resolve claim for payment.Responsible for handling all inbound and outbound calls to patients in order to ensure account accuracy.Researches problem accounts to ensure accuracy for full payments or arrange payment plan to resolve account.Models appropriate behavior in handling of difficult patients.· Operates within the guidelines of the Fair Debt Collection Practices Act (FDCPA), Health Insurance Portability and Accountability Act (HIPAA) and any other applicable Federal or state laws and company policies.

Maintains good rapport with patients, physicians, 3rd party payors and other department representatives.

Works effectively with other staff members to accomplish work and departmental goals.

Uses and demonstrates understanding of the applicable computer systems, including system reports and security procedures.

Ability to resolve insurance denials and file appeals with government and commercial carriers

Performs various collection actions including contacting patients by phone, updating insurance information, and follow through on insurance process.

Maintain excellent customer relationships to ensure customer satisfaction

Initiate and perform additional billing responsibilities to meet set goals.

Analyze the unpaid claims and denials and identify/investigate the reasons for nonpayment and which action is needed to resolve timely.

Study and understand contractual terms and conditions of payment. Make sure payments are consistent with the terms.

Adheres to applicable policies, hospital/physician billing/departmental practices and 3rd party requirements.

May be required to utilize add on software such as: SSI, IDX/Centricity (preferred), Epic, FasTrack, Meditech, Cerner, and various other systems.

Accurately and efficiently processes the account including transaction recording and other functions.

Stays up to date on contract, regulation, procedure and other changes affecting the department.

Reports unusual accounts, account problems and workflow issues promptly to manager.

Demonstrates positive and professional communication skills.

Performs other work duties as assigned

3-5 years of insurance follow-up experience in a hospital or physician’s office setting is preferred

Thorough understanding of CPT, DRG, HCPC, Procedure and Revenue codes, modifiers and their effect on reimbursement

Experience with filing UB-04 and HCFA 1500 claim form required

Key Competencies:

Results-Oriented

Strong written and verbal communication skills

Ability to handle and maintain confidential information

Strong work ethic

Job Requirements:

High School Diploma required, AA+ preferred

Minimum of 3-5 years of insurance billing and follow-up experience