Account Follow-Up Representative II - MEDHOST INC

The Account Follow-up Representative II is responsible for the review and resolution of outstanding insurance balances on hospital patient accounts. The Account Follow-up Representative II is required to learn multiple hospital systems, conduct research analysis, utilize intermediate skills to work basic to complex outstanding insurance claims, work closely with third party payors to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims.

Primary Duties:

• Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution
• Work an average of 40-50 accounts per workday for assigned payor(s)
• Assigned Payor denials and Zero ($0) pay reports worked within 24 hours of receipt
• Gather additional demographic, clinical information, medical records, authorizations, and insurance related information deemed necessary to pay outstanding medical claims and update the applicable systems with the patient’s information
• Ability to prioritize job responsibilities and manage time effectively for completion of assignments
• Analyze, communicate, and participate in resolving denial/variance trends and payor issues with other teams/departments within the organization
• Identifies and prepares less complex claims for reconsiderations and appeals
• Assists leadership in managing assigned A/R and ensure resolution of outstanding insurance balances at 90 days post discharge
• Works closely with third party payors and takes next steps to reach resolution of outstanding insurance balances. 
• Must have the ability to deliver education and training for new hires along with assisting less experienced representatives.
• Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows
• Review and recommend adjustments to accounts in accordance with payor, company, and client guidelines
• Participate and complete projects assigned by team lead or manager to fulfill clients’ contractual agreement of services
• Work in partnership with other teams/departments regarding resolution of project issues, concerns, and workflows
• Complete assigned LinkedIn learning path within the calendar year
• Attend role-based education courses within the calendar year
• Assists leadership with special projects and/or stretch assignments
• Other duties as assigned

Administrative Duties:

• Accurately input/submit worked time by the required departmental deadlines
• Maintain knowledge of insurance payors and collection regulations
• Maintain industry knowledge through self-study and by attending training classes
• Attend and participate in team and departmental meetings
• Effectively responds to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from patients, agencies, and facilities in a timely manner 
• Adherence to all HIPAA Privacy and Security requirements and responsibilities  
• Perform duties and responsibilities in a positive manner that upholds company policies and procedures

Other Skills:

• Knowledgeof revenue cycle processes impacting insurance reimbursements
• Knowledgeoftheinsurancefollow-upprocesseswithunderstandingofthefundamentalconceptsinhealthcare reimbursement methodologies
• Solid understandingofInstitutional(UB04)andProfessional(1500)claimforms required
• Use critical thinking skills and payor knowledge to recommend system edits/updates to reduce denials and result in prompt and accurate payment
• Proficiency with telephone systems for outbound/inbound calls
• Access protected health information (PHI) in accordance with departmental assignments and guidelines
• Skilled in making accurate arithmetic computations
• Excellent communication, good judgment, tact, initiative, and resourcefulness
• Must be detail oriented, organized, and ability to multi-task
• Possess ability to concentrate for long periods of time
• Ability to work individually and/or as part of a team
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives
• Must be flexible with a “can do” attitude and the ability to remain professional under high pressure situations
• Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe
• Understand both oral and written directives

Training and Experience:

• High School or equivalency diploma required
• 0-3 years’ experience in related field (recent graduate of Medical Billing and Coding coursework accepted in lieu of experience)
• Must be able to follow directions and to perform work according to department standards independently
• Must be emotionally mature and able to function effectively under high pressure situations
• Sufficient in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned
• Customer Service oriented

Other Requirements:

• High Speed Internet access and unlimited data
• Smart phone for DUO authentication
• Negative pre-employment drug tests
• Criminal and MVR backgrounds meet our company hiring criteria

Salary:

• $26/hr