Insurance Follow Up Rep

Commonspirit; Omaha (NE); On-site; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking an Insurance Follow Up Rep to enhance their team. This role is crucial for managing insurance claims and ensuring timely reimbursements. The ideal candidate will leverage their knowledge of medical billing and insurance processes to address outstanding balances and resolve issues efficiently. With a focus on customer service, you'll communicate effectively with payers and maintain accurate documentation. Join a supportive environment that values work/life balance and offers comprehensive benefits, including health insurance, paid time off, and tuition assistance for career growth.

Benefits

Health/Dental/Vision Insurance

Tuition Assistance

Paid Time Off

Employee Assistance Program

Wellness Programs

Matching 401(k)

Flexible spending accounts

Adoption Assistance

Premium Access to Family Care Program

Voluntary Protection Plans

Qualifications

• Knowledge of healthcare policies and practices.
• Ability to understand insurance reimbursement terms.

Responsibilities

• Correspond with insurance payers to resolve outstanding balances.
• Conduct follow-up activities through various communication methods.

Skills

Knowledge of medical insurance

Ability to communicate effectively

Attention to detail

Customer service skills

Ability to troubleshoot

Education

High School Diploma or equivalent

Post-high school program in medical billing

Tools

Practice management system

Office equipment

Job description

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Join to apply for the Insurance Follow Up Rep role at CommonSpirit Health

*Overview*

CHI Health strives to care for you the way you care for your patients.

We understand you have personal responsibilities outside of your profession and also care about your well-being.

*With you in mind, we offer the following benefits to support your work/life balance:*

* *

• Health/Dental/Vision Insurance
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO)
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts
  
  

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

*Responsibilities*

The Insurance Follow Up Rep is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
• Assists with unusual, complex or escalated issues as necessary.
• Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
• Accurately documents patient accounts of all actions taken in billing system.
• Other duties as assigned by leader and organization.
  
  

*Qualifications*

*Required Minimum Knowledge, Skills and Abilities*

• Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
• Knowledge of medical insurance, payer contract, CPT and ICD codes.
• Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
• Knowledge of the operation and application of automated systems applicable to the assigned function.
• Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
• Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
• Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
• Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
• Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
• Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
• Ability to effectively prioritize and execute tasks while under pressure.
• Ability to demonstrate excellent customer service skills, including professional telephone interactions.
• Ability to read, understand and communicate in English sufficient to perform the duties of the position.
• Ability to establish and maintain effective working relationships as required by the duties of the position.
  
  

Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.

*PREFERRED Qualifications*

High School Diploma or equivalent preferred

Graduation from a post-high school program in medical billing or other business related field is preferred

Two years of revenue cycle or related work experience preferred

*Pay Range*

$16.26 - $22.36 /hour

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Sales and Business Development

• Industries

  Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices

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