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The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.
Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable.
Identifies billing errors for correction and resubmits claims to insurance carriers.
Follows up on payment errors, low reimbursement and denials.
Reviews insurance EOB’s and initiates appeals as necessary.
Prints and mails UB04s or HCFA 1500s as necessary for account resolution.
Remains up to date with all commercial and managed care pricing models, rules and regulations.
Remains up to date with all Medicare and Medicaid rules and regulations.
Supports Company’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Company’s business practices. This includes: becoming familiar with Company’s Code of Ethics, attending training as required, notifying management or Company’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
High school diploma or GED.
At least one year of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers.
Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement, and denials.
Experience reviewing EOB and UB-04 forms to conduct A/R activities.
Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
At least one year of experience with accounts receivable software.
Experience navigating payer sites for appeals/reconsiderations, benefits verification, and online claims follow up.
Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
Demonstrated success working both individually and in a team environment.
Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
Ability to work effectively with cross-functional teams to achieve goals.
Demonstrated ability to meet performance objectives.
Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian, Collections Management or STAR.
Experience working with or for a hospital/hospital system with more than 250 beds.
Experience with both hospital (facility) and physician (pro-fee) A/R.
Be Inspired. Ignite Change. Transform Health Care.
From Patient-to-PaymentSM, Company provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the Company CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.
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