- Documents all responses and actions taken to reach claim or account resolution in the practice management system.
- Exhibits strong communication skills and positive attitude with internal (team members, other departments, providers and leadership) and external customers (patients, insurance companies, vendors and employers). Directs customer complaints to management for immediate response if unable to resolve.
- Follows workflow process to ensure correct registration, coding, payment/adjustment posting and insurance processing of claims.
- Conducts verbal and written inquiries to determine the reasons for unpaid/denied claims to reach resolution.
- Successfully manages claims in assigned worklists to meet/exceed productivity standards.
- Participates as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.
- Selects priorities and organizes work and time to meet them in order of importance.
- Ensures claims are submitted to the appropriate responsible party within designated filing limit guidelines and makes certain that appropriate claim resolution is a priority of the department.
- Recognizes and researches problematic trends regarding non-payment in an effort to implement preventive measures to increase velocity of cash collections.
- Travels to practice locations to provide on-site support and participates in regular meetings with practice leadership to promote positive revenue cycle performance outcomes.
- Maintains the confidentiality of all patient records and accounts.
- Actively participates in staff meetings and process improvement planning sessions.
- Maintains work area in a clean and orderly fashion making sure all source documents are stored electronically on the shared network.
- Understands HIPAA policies and procedures and uses this knowledge to practice in a manner that maintains the confidentiality of protected health information (PHI) in compliance with HIPAA.
- Performs other duties as assigned.
- Education: High School diploma or equivalent
- Skills:
- A basic understanding of insurance requirements and regulations, contract benefits, credit and collection procedures, financial assistance programs as well as a familiarity of medical terminology.
- Advanced reading, writing and oral communication skills as well as the knowledge to perform mathematical calculations.
- Interpersonal skills necessary for making patient and third-party payer contacts. Must be able to work with interruption by co-workers or other internal customers needing assistance with patient accounts.
- Analytical and critical thinking ability to diagnose account issues and active listening skills to provide service excellence. Demonstrated project and time management skills and an ability to work effectively over the phone and in a team environment.
- Demonstrated proficiency in data entry and computers.
- Years of experience: 2-5 years in resolving insurance denials and/or revenue cycle
- Skills:
- Knowledge of CPT and ICD terminology.
- Familiarity with billing software.
- EPIC experience.
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Insurance Follow Up Specialist - Napoleon, United States - University of Toledo
Description
University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family. The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians practice at hospitals and medical offices throughout the region.
University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.
The Insurance Follow Up Specialist performs job duties in accordance to established procedures, policies and detailed instructions, drive resolution and promote peak performance while delivering world class revenue cycle outcomes. This position interacts daily with team members, insurance representatives and other departments in an effort to quickly resolve outstanding account balances while enhancing the patient experience and promoting code of conduct to ensure integrity and compliance.
ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES:
REQUIRED QUALIFICATIONS
PREFERRED QUALIFICATIONS:
WORKING CONDITIONS:
Works in an open office environment; area is well ventilated, lighted, and close to equipment and materials required for daily work functioning.
The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace
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