The primary responsibility of this position is to follow-up with insurance payers on outstanding claims, break down obstacles to payment, and accelerate cash collections.
Duties & Responsibilities:
Responsible for follow-up and collecting on accounts in assigned inventory. Utilizes experience and follow-up strategies and tools to resolve claims and obtain payment.
Escalates unpaid claims to payer claims supervisor as appropriate when regular follow-up efforts are not successful.
Documents client’s host system utilizing the 5 W’s framework and related policies/procedures to ensure accurate and complete documentation and then copies account notes into Amplify’s workflow tool
Assigns appropriate status codes (e.g. root cause, action, etc.) in Amplify’s workflow tool so trends can be identified and addressed.
Writes first and second level appeals of all denials in effort to overturn and secure payment. Escalates payer denial and other trends to Management for further assistance.
May also work assigned underpayments as assigned by Management.
Maintains client and/or position specific daily productivity and quality expectations.
Researches and analyzes any correspondence received related to assigned accounts.
Knowledge, Skills, and Abilities:
Must adapt and demonstrate the ability to work independently from home in a fast-paced, changing and goal-oriented environment.
Direct account follow-up and/or billing experience.
Medical Terminology, ICD-10, CPT and DRG knowledge preferred
Knowledge of third-party Insurance payer guidelines.
Intermediate experience in Excel preferred.
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
Demonstrates understanding of the entire revenue cycle.
Must be detail oriented, organized, and possess the ability to apply critical thinking skills.
Assists with problem solving, inquiries, and customer interaction to ensure positive results.
Work Experience, Education, and Certifications:
High school diploma or equivalent; additional training in hospital insurance collections is a plus.
3-5 years of collections experience in a Hospital Business Office
Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment.
The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools.
Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain.
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