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.
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.