Follow Up Specialist
Company: Memorial Health
Location: Springfield
Posted on: May 6, 2024
Job Description:
Overview
Follows up on outstanding payments due on all types of open medical
insurance claims, i.e., managed care and commercial. Coordinates
activities with external insurance companies for the resolution of
patient account balances. Ensures compliance with managed care
guidelines and MMC organizational policies. Embodies the Memorial
Health System Performance Excellence Standards of Safety, Courtesy,
Quality, and Efficiency that support our mission, vision and
values.
Qualifications
Education:
- Education equivalent to graduation from high school or GED is
required.
Experience:
- Two or more years as an Account Follow-Up Specialist, or
comparable years of medical insurance and/or health care billing
experience is required. Possesses the technical knowledge to
independently process claims of any denomination, type, and
complexity is required.
Other Knowledge/Skills/Abilities:
- Demonstrates thorough knowledge of the electronic billing
system, medical terminology, medical procedural (CPT) and diagnosis
(ICD-9 CM) coding, DRGs and hospital billing claim form UB-04 is
required.
- Demonstrates a thorough knowledge of contract management
systems and Blue Cross and Tricare guidelines.
- Basic working knowledge of personal computers and their
associate user software is required. Experience with Microsoft
Office products Word and Excel is preferred.
- Ability to work within the guidelines of defined managed care
contract policy provisions and company procedures.
- Demonstrated ability to work successfully with internal
customers and external contacts is required.
- Possesses highly-developed prioritization and organization
skills and critical thinking and problem solving ability.
- Demonstrates excellent communication skills, including
telephone etiquette, and keyboarding and basic math skills.
Responsibilities
- Accesses external insurance providers' websites to determine
and/or verify patients' insurance eligibility and account
status.
- Receives and examines daily listings for all denominations and
types of patient accounts and determines which require further
analysis and action.
- Investigates assigned patient accounts with
incomplete/incorrect information and resolves problems or errors to
ensure complete and compliant information accompanies the
claim.
- Follows up and investigates all denominations and types of
unpaid items and other issues associated with unpaid claims.
Contacts patients, guarantors, or other sources of third party
payment and secures arrangements for prompt payment.
- Embodies the Memorial Health System Performance Excellence
Standards of Safety, Courtesy, Quality, and Efficiency that support
our mission, vision and values:
- Receives and researches insurance claim denials, rejections and
underpayments, and as necessary, prepares the necessary paperwork
to appeal the denial.
- Reviews correspondence relating to payments and claims;
conducts the necessary research to provide supplementary background
information regarding the inquiry
- Researches and resolves complex issues associated with patient
insurance accounts. As applicable, identifies, documents, and
reports problematic trends to management.
- Analyzes reports containing rejected account information and
performs the necessary research to resolve the reason(s) for the
rejection and secures any other required information.
- Provides input regarding system edits designed to identify and
ensure consistent and compliant data necessary for processing
medical insurance claims.
- Responds to requests from internal departments regarding the
proper coding, billing, and processing of medical insurance
claims.
- Communicates and resolves issues with a variety of internal and
external sources to resolves issues involving medical insurance
claims. This may include internal departments, patients (or other
responsible parties), third-party payors, social service agencies,
Medicare/Medicaid staff, other insurance carriers, service
providers, and collection agencies.
- Initiates corrections to all denominations and types of charges
and contractual/allowances within scope of expertise and authority
granted.
- Identifies and calculates write-off amounts and secures the
necessary approvals from management for processing.
- Documents online systems and electronic files to ensure
accurate data is noted regarding the status of claims and
payments.
- Researches complex issues on all denominations and types of
accounts and coordinates their resolution in a timely manner.
- Ensures compliance to managed care contract guidelines and
processes at each work step to facilitate accurate and timely
reimbursements to the organization
- May assist with special projects, analyses, or audits.
- As directed and defined by management, orients and cross-trains
on other unit duties which are outside of regularly assigned area
of responsibility. May serve as a back-up for other areas within
the unit or department, especially during times of special needs or
staff absences.
- Performs other related work as required or requested.
The intent of this job description is to provide a representative
summary of the major duties and responsibilities performed by
incumbents of this job. Incumbents may be requested to perform
tasks other than those specifically presented in this description.
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Keywords: Memorial Health, Saint Peters , Follow Up Specialist, Other , Springfield, Missouri
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