Insurance Follow-up Specialist

Summary/Objective
Under limited supervision the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution patients and the insurance agency. They assist in filing insurance claims determining correct reimbursements/ adjustment/write-offs and denial management. They also analyze plans to determine which benefits are covered submit secondary insurance claims generate patient statements and follow-up on those submissions.

Essential Job Functions

• Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
• Analyze claims (denial/non-denial) in practice management systems internal system and direct toward resolution (Payment Adjustment & self-pay).
• Technical billing and denial follow-up on all assigned payer claims
• Call Payer (Insurance/ third parties) to resolve claims (denial/non-denial) after review from PMS internal system & process toward resolution (Payment Adjustment & self-pay).
• Identify potential process improvements trends issues and escalate to Supervisor.
• Be part of initial and all ongoing training session to enhance knowledge of RCM processes.
• Resolve complex patient account issues requiring investigation of system timeline comments payer reimbursements and account transactions.
• Identify trends/payer issues and escalate complex payer issues to the lead billing specialist as necessary.
• Maintain a working knowledge of client policies and the Workflow documentation like SOPs Update tracker Issue Log and Trend logs.
• Maintain quality standards as determined by management.
• Assist the Manager or Team Lead in working priority reports promptly effectively and efficiently.
• Maintain accurate records within a collections database.
• Be a mentor to new employees and assist in their training and development.
• Performs other duties as directed.
• Perform duties in compliance with Companys policies and procedures including but not limited to those related to HIPAA and compliance.

Key Success Indicators/Attributes

• Ability to prioritize and multi-task in a fast-paced changing environment.
• Demonstrate ability to work in all work types and specialties.
• Demonstrate ability to self-motivate set goals and meet deadlines.
• Demonstrate leadership mentoring and interpersonal skills.
• Demonstrate excellent presentation verbal and written communication skills.
• Ability to develop and maintain relationships with key business partners by building personal credibility and trust.
• Maintain courteous and professional working relationships with employees at all levels of the organization.
• Work in accordance with corporate and organizational security policies and procedures understand personal role in safeguarding corporate and client assets and take appropriate action to prevent and report any compromises of security within scope of position.
• Demonstrate excellent analytical critical thinking and problem-solving skills.
• Manage the Individual KRAs as per the provided metrics.
• Understand client requirements and specifications of the project & Ensure targeted collections are met on a daily / monthly basis.
• Meet the productivity targets of clients within the stipulated time. Ensure timely follow up on pending claims and to prepare and Maintain individual status reports.
• Skill in operating a personal computer and utilizing a variety of software applications is essential.
• Knowledge of coding convention and rules established by the AHIMA American Medical Association (AMA) the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS) for assignment of diagnostic and surgical procedural codes is an added advantage.
• Knowledge of JCAHO coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage.

Supervisory Responsibility

No

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment suchas computers and phones.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job the employee is occasionally required to stand; walk; sit; use hands to finger handle or feel objects tools or controls; reach with hands and arms; climb stairs; balance; stoop kneel crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision distance vision peripheral vision depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Schedule is M-F 8am-4pm EST without a lunch with a lunch it is M-F 8am-430pm EST. This position occasionally requires long hours and weekend work.

Travel

Minimal travel required; up to 5%

Required Education and Experience

Knowledge of medical and insurance terminology such as CPT ICD-9 ICD-10 HCPCS co-pay deductible or co-insurance and full understanding of hospital/physician billing. Minimum 1-2 years experience in Medical Billing/Coding and experience with standard office software products. High School diploma or equivalent.

Preferred Education and Experience

N/A

Additional Eligibility Qualifications

N/A

Security Access Requirements

In addition to the specific security access required by the employees client engagement the employee will have access to the Omega set forth in the Omega Field Employee profile.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race color religion national origin gender age sexual orientation gender identity or expression marital status mental or physical disability protected veteran status and genetic information or any other basis protected by applicable law. Omega Healthcarealso prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application interview or any other part of the hiring process please contact Human Resources at.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this responsibilities and activities may change at any time with or without notice. Employee may perform other duties as assigned.