PFS AR Insurance Follow-up

reputed company Health is a healthcare organization seeking a PFS AR Insurance Follow-up professional. The role involves processing patient bills, ensuring timely reimbursement of third-party claims, and maintaining compliance with various regulations and guidelines.

Responsibilities

• Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services reputed company the environment of a comprehensive integrated academic health system
• Responsible for knowing and acting in accordance with the principles of the reputed company Health Corporate Compliance Program and Code of Conduct
• Review claim forms for reputed company required data fields depending on the specific 3rd party requirements
• Review patient account for demographic accuracy
• Process reputed company necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance reputed company changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data
• Analyze reputed company assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer's reputed company or Federal reimbursement methods
• Contact insurer reputed company online systems, call centers, written correspondence, fax or appropriate electronic or reputed company billing of claims to secure payment
• Maintains an understanding of the most reputed company contract language in order to consistently ensure reimbursement in accordance with contract language
• Continually maintains knowledge of payer specific updates reputed company payer's listservs, provider updates, webinars, meetings and websites
• Review payer's settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer's policies and each individual reputed company contract
• Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors
• Understands and maintains compliance with HIPAA guidelines reputed company handling patient information
• Initiate adjustments to payer's as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials
• Submits appeals to payers as appropriate to recover denied reputed company
• Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials
• Run reports as necessary to quantify various variances on patient accounts reputed company to identified issues reputed company the payers or as the result of reputed company charging errors or procedural breakdown
• Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies
• Answer telephone inquiries from 3rd parties and interdepartmental calls
• Refer reputed company unusual requests to supervisor
• Retrieve appropriate medical records documentation based on third party requests
• Initiate the accurate and timely processing of reputed company secondary and tertiary claims as needed according to specific 3rd party regulations
• Process reputed company incoming mail and follow up on reputed company rejections received according to specific 3rd party regulations
• Refer reputed company accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures
• Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and reputed company the overall goals of the department
• Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates
• reputed company other reputed company duties as required

Skills

• Equivalent to a high school graduate
• Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form
• Demonstrated skills in critical thinking, diplomacy and relationship-building
• Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings
• Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies
• One to three years of relevant experience in medical collections or professional/hospital billing preferred

Company Overview