Billing Follow-Up Representative (Glendale, CA - On Site) - PrimeMSOSurgicalCenters

Job Description

The Billing Follow-Up Representative is responsible for reviewing, researching, following up, and processing medical claims in accordance with contracted and commercial health plan policies. This role involves determining the extent of liability and entitlement, adjudicating claims, and addressing rejections, and denials within the revenue cycle process. The representative takes guidance from the case manager and collaborates closely with the verifications, authorizations, billing, and collections teams to ensure effective and efficient claim resolution within timely filing limits.

Job Responsibilities: 

• Review claims and translate payor remittance requests to practice management system; and prepare claims for return to payor/provider/subscriber if additional information in needed. 
• Maintaining all appropriate billing records and following up on suspended claims; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general inquiry issues, then communicating the results to the case manager via written case notes and verbal collaboration. 
• Ability to review EOBs and remittance advice for any payment inconsistencies or errors.
• Save applicable billing recording into organizational drives via naming conventions.
• Work closely with insurance companies and third-party payors to collect revenue for surgical services performed.
• Contacting insurance companies to follow-up on claims, appeals, and requested document statuses.
• Ensuring all communication and interaction with payors and patients is documented in practice management software.
• Assists in resolving reimbursement issues with contracted and non-contracted payors. (HMO, PPO, EPO, POS, Worker’s Com., Medicare, self-pay and third-party payors).
• Processes denials and submit corrected claims by collaborating with the case manager, insurance payors and/or patients on current and past due accounts.
• Responsible for thorough and timely follow-up on pending claims in all revenue cycle states to ensure accurate accounts receivable matrix are maintained.
• Meeting and maintaining timely filling limits on pending actions for claims.
• Prepares and submits claims to insurance companies, third party organizations, or self-payers as required.
• Assist in authorizations and verifications, if required.
• Assist and complete Ad Hoc assignments by management, as required. 
• Consistently achieve organization’s defined metrics.

Skills and Qualifications: 

• Ability to read and comprehend instructions, detailed correspondence and memos
• Ability to write correspondence
• Ability to multi-task and work in a fast-paced environment 
• Knowledge of MS Office including Excel and Word
• Knowledge of Vision software
• Understanding of medical terminology and medical coding 
• Experience with medical billing software and applications (preferred) 
• Excellent written and verbal communication skills

Requirements:

• Associate degree or higher in related field (preferred) 
• Two years medical insurance collections and billing experience (preferred) 
• Department of Justice Background Check
• Satisfactory Completion of Health/Drug Screening
• Proof of legal US work eligibility

Company Description

Since 2014, Prime MSO has developed and managed surgical facilities that provide patients with the highest level of surgical care. Today we are one of the reliable and independent operators of outpatient surgery centers in the Los Angeles area, covering virtually the full range of surgical specialties.

Our remarkable community of teammates, physician partners and health system partners are deeply committed to providing quality patient care and improving healthcare in America. Our focus on building strategic relationships with our partners enables us to acquire, develop and optimize facilities in an aligned economic model that enables better access to high-quality care at a lower cost.

While healthcare is in a constant state of change, we want to make sure it is always for the better. We believe that happier, more fulfilled employees and staff in a fun and dynamic work environment will ultimately provide the best care in the country. At Prime MSO, that means success. Talk to any of our employees about their experiences and hear the difference Prime MSO is making in their lives today.

Benefits

• Health insurance
• 401(k) match
• Dental insurance
• Disability insurance
• Life insurance
• Paid time off
• Vision insurance
• Paid holidays
• Bereavement leave

Part Time

• Paid time off

Workplace Benefits:

Prime believes in fostering a rewarding and caring workplace environment. We understand the importance of work-life balance and appreciate the time our employees invest in us. To show our appreciation, we strive to create a fun environment. We celebrate all staff birthdays and major life events. We have at least two company-wide events each year including Derby Days where all Prime staff are invited to attend a fully paid for trip to racing tracks on a race day and a Holiday party usually at an upscale restaurant in downtown LA. We celebrate holidays at individual locations throughout the year including potlucks for Thanksgiving and Secret Santa or White Elephant events during winter. Working at Prime is like working with your closest friends and family.

We also strive to give back to our community. We proudly host food drives, toys for tots, and raise money for local charities in our area. When creating and conducting these charitable events, we always choose local charities where we can see where the charitable efforts in action.

To promote good work-life balance, we have adopted a competitive PTO policy where all first-year full time employees accrue 14 total days of PTO (almost three weeks of paid time off). The number of PTO days able to accrue increases with each year of employment too. We offer 48 hours of paid sick time to all full-time employees with part-time and even per diem employees able to accrue paid sick time based on hours worked. We also offer paid bereavement leave in the event of a close family member passing away.

Vision and Dental insurance are fully paid for by the company. We offer generous contributions to all medical health plans with increased contribution to managers. Our medical plans offered include HMO and PPO options with infertility coverage. As a Prime employee, you also have unique access to our surgical facilities and doctors for health needs as Prime strongly believes in the importance of access to good and affordable medical care.

Prime strongly values continued education and training for our employees. We assist our nursing staff in obtaining certifications when necessary and offer a tuition reimbursement program. We offer cross-training at our facilities so our employees can broaden their knowledge, skill, and experience. We believe in the importance of meeting your full potential and do all we can as a company to help you achieve it.