PFS Insurance Follow-Up Rep Ambulatory Denials

Banner Health; Baton Rouge (LA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a PFS Insurance Follow-Up Representative to manage billing and collection activities. This remote role requires at least 1 year of experience in medical insurance accounts receivable and strong writing skills for appeal letters. Ideal candidates should have advanced proficiency in Microsoft Excel. Join our committed team to enhance patient financial services and ensure timely reimbursement for healthcare services.

Qualifications

• Minimum of 1 year experience in Medical Insurance AR and/or Physician Fee for Service Billing.
• Minimum of 1 year experience writing appeal letters for payer/payor denials.

Responsibilities

• Process payments, adjustments, claims, correspondence, refunds, and denials.
• Reconcile account balances and payments, working with payor remits and contracts.
• Research payments and claims to determine discrepancies.
• Build relationships with internal and external customers to correct issues.
• Make inbound and outbound calls to resolve billing issues.

Skills

Medical Insurance AR

Writing appeal letters

Intermediate to Advanced Microsoft Excel

Education

High school diploma/GED

Job description

Department Name: Amb Billing & Follow Up

Work Shift: Day

Job Category: Revenue Cycle

Estimated Pay Range: $17.58 - $26.36 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certification. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members.

Job Summary

The PFS Insurance Follow-Up Representative (Ambulatory Denials) is responsible for following up with assigned payer for various denials, such as no authorization, eligibility denials, etc. This position is a higher-level PFS role, as it does range across all groups of patients and all types of provider specialties. Experience within medical insurance accounts receivable (AR) and physician fee-for-service billing is ideal.

Location: Remote

Schedule: Monday-Friday, varying shifts 6am-6pm after successful completion of training program.

Ideal Candidate

• Minimum of 1 year experience in Medical Insurance AR and/or Physician Fee for Service Billing;
• Minimum of 1 year experience writing appeal letters for payer/payor denials;
• Intermediate to Advanced skill level in Microsoft Excel.

Remote Work: This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV, WY

Position Summary

This position coordinates and facilitates patient billing and collection activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner.

Core Functions

1. Processes payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner.
2. Reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company's collection/self-pay policies to ensure maximum reimbursement.
3. Researches payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary.
4. Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems.
5. Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues.
6. Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances.
7. Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately.

Minimum Qualifications

High school diploma/GED or equivalent working knowledge. Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience.

Preferred Qualifications

Work experience with the Company's systems and processes is preferred. Previous cash collections experience is preferred.

Anticipated Closing Window (actual close date may be sooner): 2026-01-28

EEO Statement: EEO/Disabled/Veterans