INSURANCE FOLLOW UP REP 2019-R0269779
Day Shift Chattanooga, TN
Under general supervision, the Insurance Follow-up Rep is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and denials for the Memorial Health Partners Foundation (MHPF) 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.
Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues.
In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.
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 received for all FMG providers.
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.
Identifies potential trends in denials/reimbursement by payer or by type, denial reason, or coding issue and reports to supervisory staff for appropriate escalation.
Uses critical thinking skills and payer knowledge to recommend system edits to reduce denials and result in prompt and accurate payment.
Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
Communicates with supervisor and staff regarding insurance carrier contractual and regulatory requirements that impact payment and denials.
Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
Meets quality assurance and productivity standards for timely and accurate denial resolution in accordance with organizational policies and procedures.
Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
Understands detailed billing requirements, denial reason codes, and insurance follow-up practices.
Understands government and commercial insurance reimbursement terms, contract language, and appropriate reimbursement amounts.
Has knowledge of, and is compliant with, government regulations including signature on file requirements, compliance program, HIPAA, etc.
Establishes and maintains professional and effective relationships with peers and other stakeholders.
Works collaboratively with payers and revenue cycle staff to explain denial or underpayment issues.
Establishes and maintains a professional relationship with clinics and FMG staff in order to resolve issues.
Promotes an atmosphere of collaboration so peers feel comfortable approaching with issues and challenges specific to their payer or specialty.
Depending on role and Epic training, may be called upon to support other areas in the Revenue Cycle.
Performs related duties as required.
High school diploma or equivalent required.
Experience: Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.
Graduation from a post-high school program in medical billing or other business-related field is preferred.
Additional Responsibilities: Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
Adheres to and exhibits our core values:
Reverence: Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
Integrity: Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
Compassion: Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
Excellence: Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
Maintains confidentiality and protects sensitive data at all times.
Adheres to organizational and department specific safety standards and guidelines.
Works collaboratively and supports efforts of team members.
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers
This position requires a criminal background check.
Therefore, you may be required to provide information about your criminal history in order to be considered for this position.
Additional Information Requisition ID: 2019-R0269779
Schedule: Full-time Shift: Day Job
Market: CHI Memorial About Us
CHI Memorial is a not-for-profit, faith-based healthcare organization dedicated to the healing ministry of the Church.
Founded by the Sisters of Charity of Nazareth and strengthened as part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation services.
CHI Memorial is a regional referral center of choice with 3,400 associates and more than 700 affiliated physicians providing health care throughout Southeast Tennessee and North Georgia.
Equal Opportunity Employment Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers.
Qualified applications will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disability or any other legally protected characteristic
About this company
Memorial Health Care System is a not-for-profit, faith-based healthcare organization dedicated to the healing ministry of the Church. Founded by the Sisters of Charity of Nazareth and strengthened as part of Catholic Health Initiatives, it offers a continuum of care including preventative, primary and acute hospital care, as well as cancer and cardiac care, orthopedic and rehabilitation services. Memorial is a regional referral center of choice with 4,000 associates and more than 700 affiliated physicians providing health care throughout Southeast Tennessee and North Georgia. Memorial Health Care System is recognized as one of the nation's 100 Top Hospitals® by Thomson Reuters, the health care industry's leading source of information on hospital quality.
Location/Region: Chattanooga, TN (37404)