Insurance Follow Up at Prestige Staffing

Physician Insurance Claim Follow Up Overview:

Seeking detailed oriented candidate with strong problem-solving & verbal-written communication skills, as well as excellent time management.

• Review patient accounts for resolution- check status with insurance company for billed claims that have not processed & determine what may be needed in order for claim for finalize.
• Review accounts with full or partial claim denials to find out root-cause & determine best course of action for proper resolution.
• Responsible for learning & understanding payer rules, as well as state/federal guidelines.
• Responsible for prioritizing & completing work per the department???s productivity & quality standards.
• Responsible for facilitating communication between insurance company and the patient to resolve issues holding up claims processing, such as: incorrect demographic information or coordination of benefits.
• Responsible for facilitating communication between departments in order to correct any issues with billed claims to ensure correct billing and proper claim processing.

Position Summary: 

This position has the responsibility of working patient accounts as defined by the department established policies and procedures under the Manager and Supervisor within the department. Specifics and volume of work is defined by the functional area within the Business Office that the employee is assigned. All work shall be completed in a timely and accurate manner. 

• Assists Supervisor to recognize and identify issues pertaining to the working of accounts.
• Demonstrates the ability to handle varying tasks as well as understanding and interpreting procedures relative to the revenue process.
• Demonstrates knowledge of State and Federal regulations, HIPAA guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance.
• Recognizes situations, which necessitate supervision and guidance, seeks appropriate resources.
• Adheres to established departmental policies and procedures, objectives, process improvement initiatives, safety, environmental and infection control standards.
• Demonstrates an ability to understand the payer requirements of insurance carriers
• Demonstrates an understanding of all patient information from the facilities and the specifics of each follow-up to ensure appropriate reimbursement is received.
• Professionally deals with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Performs specific functions relating to collection of patient accounts.
• Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices, and other facility personnel using verbal, nonverbal and written communication skills.
• Consults and works collaboratively with Supervisors, Co-workers, Department Manager, and other facility personnel, effectively performing tasks of position.
• Attends meetings as required and participates on committees as directed.
• Promotes good public relations for the department and the facilities, adhering to desired behaviors.
• Assists Vice President, Director, Managers and Supervisors on activities and projects, as needed.
• Participates freely in intradepartmental quality improvement activities whenever called upon to do so.
• Provides assistance to new employees.
• Attends required In-Service training as scheduled.
• The KBOS Constitution for developing people which are; commit time to learning and development, help others obtain the information and skills they need to succeed on the job and utilize training, education and development opportunities.
• Demonstrates promptness in reporting for and completing work, ensuring follow-through on assigned tasks.
• Demonstrates initiative in increasing skills and attends training programs as available
• Utilizes resources available appropriately, i.e. use of equipment and supplies.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.