UW Physicians -
701 Fifth Ave, Ste 700
Seattle , WA , United States
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Insurance Follow Up Specialist at UW Physicians

This job posting is no longer active

Updated: February 21, 2017
The Insurance Follow-up Specialist is responsible for the optimal payment of claims from commercial insurers, managed care plans, and state and federal plans; this includes following up on zero pay claims (denials) as well as claims for which we have received no payor response.
  • High School Diploma or equivalency.

  • Two (2) years experience with CPT procedures codes, medical terminology and billing procedures.

Certifications/Licensure Requirements:
  • None required. 

Knowledge, Skills & Abilities: 
  • Ability to confer with customers by telephone or in person in order to provide information about charges for services, collect payments, make billing adjustments and respond to inquiries or complaints.
  • Ability to plan, organize, and effectively work with the supervisor to schedule workload and manage production backlogs in an efficient and proactive manner.
  • Knowledge of ICD9/10, CPT and HCPS coding and medical terminology.
  • Ability to complete detail-oriented work in a timely manner.
  • Ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.
  • Ability to prioritize workload and meet quality and production standards.
  • Aility to read and understand written sentences and paragraphs in work related documents.
  • Ability to work well with a variety of people and be a team player.
  • Excellent oral and written communication skills, with the ability to convey a positive and professional image, and to interact effectively with diverse personalities and backgrounds.
  •  Excellent typing/keyboarding skills with a high degree of accuracy to input data, process information and extract information in various report and presentation formats.
  • Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • Strong customer service and relationship management skills.
  •  Proficiency with Windows based software and Microsoft Office Suite products in a network environment.
  • Conducts timely and accurate work with the goal of resolving outstanding claims quickly and maximizing appropriate revenue.
  • Accurately deciphers denial reason and prospectively plans follow-up steps utilizing the Epic billing system.
  • Identifies and resolves coding issues and provide coding feedback to pro-fees as appropriate.
  • Displays sound judgment in choosing the most efficient and effective method of follow-up (includes appealing denials, taking adjustments, e-mail, websites and telephone inquiries).
  • Keeps current with payor updates and applies knowledge to assist in payment of claims.
  • Effectively communicates in writing and verbally with payors to bring resolution to claims as quickly as possible.
  • Analyzes rejection issues and compiles all information needed from a variety of resources to reconcile appeals.
  • Uses appropriate payment, adjustment or cancellation codes.
  • Documents clear and concise narrative on practice management system of steps taken to facilitate resolution of outstanding claims/issues.
  • Maintains fair work volume when compared to peers.
  • Completes any necessary overtime hours to comply with meeting established deadlines and resolving backlogs.
  • Takes proactive measures for claims follow-up to proper adjudication and uses analytical skills to trend and share denial details.
  • Takes accountability for area of expertise in searching for answers to questions. Creates an atmosphere that maximizes communication; this includes adjusting for different communication styles.
  • Works collaboratively with other UWP departments including Compliance, Payor Relations, Charge Capture, Patient Accounts & Inquiry, Claim, Payment & Credit, and Physician Services & Performance.
  • Demonstrates innovation in choice of resources used to assist in adjudication such as fee schedules, code correct, CPT references.
  • As necessary, reviews, corrects, and submits computer generated claim forms (electronic and paper) to the appropriate payor.
  • Perform other duties, as assigned.