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Insurance Follow Up Rep: will support Bismarck Market
Location: Service Center, Omaha NE
Opportunity to work from home after 6 months of working in the Omaha office.
JOB SUMMARY / PURPOSE
This job is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
ESSENTIAL KEY JOB RESPONSIBILITIES
Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
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.
Other duties as assigned by leader and organization.
Required Licensure and Certifications
High School Diploma or equivalent preferred
Graduation from a post-high school program in medical billing or other business related field is preferred
Two years of revenue cycle or related work experience preferred
Accounts Receivable experience
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