Insurance Follow-up Specialist

Department: HPMG - Corporate

Supervisor: Operational Lead

Status: Hourly

JOB SUMMARY: The Insurance Follow-up Representative position is responsible for all insurance follow-up on assigned accounts from the management team. The core responsibilities of an insurance follow-up representative include research, insurance billing and adjustment identification to ensure proper account resolution. 

ESSENTIAL DUTIES/RESPONSIBILITIES:

·Obtain Claim Status via the Telephone, Internet and/or Fax

·Review and Interpret Contractual Terms for Managed Care, Commercial, Medicare, Medicaid and Workers’ Compensation

·Obtain Supporting Documentation Regarding Insurance Follow-up Efforts

·Identify Contractual and Administrative Adjustments Billing via Electronic and Hard copy Submission

REQUIREMENTS AND QUALIFICATIONS:

Education: High school diploma or equivalent. A minimum of two years previous work experience as an insurance follow-up representative or Accounting is required. Must have full understanding of insurance follow-up processes (i.e., Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial Practices), and well-developed interpersonal skills. Experience in Anesthesia insurance follow up is a strong preference.

Skills:

·Excellent verbal and written communication skills

·Reliable attendance record

·Knowledge of EOBs, CPT & ICD-9 codes, HCFAs, UB92s, HCPCS, DRGs and authorizations/referrals

·Good problem-solving skills

·Ability to learn / stay abreast of relevant policies

·Proficient computer skills

·Ability to type a minimum of 40 wpm

·Detail oriented and well organized

·Outstanding listening skills

·Ability to perform under pressure in a calm manner

·Basic math skills

·High degree of accuracy

·Positive attitude

·Flexible

·Team player

Work Environment/Physical Requirements: The work is mainly sedentary, but may require walking, bending, standing, and/or carrying of light items such as files, manuals, and medical records.