Medical Administrative Assistant
Title: Insurance Follow-Up Representative (Two Openings)
Department: Patient Accounts
Hours: 9:00 am-5:00 pm, Monday - Friday
Pay Range: $25.88-$38.84 per hour
Interview process: 1st interview virtual, 2nd interview in-person.
Candidates must have experience using PivotTable and VLOOKUP in Excel.
Responsible for initiating follow-up to third-party payers on outstanding accounts, reviewing insurance correspondence, and responding promptly. Responsible for supplying third-party payers with appropriate billing information to adjudicate a claim. Responsible for ensuring appropriate payment was received in accordance with contract terms, and reporting trends, and collaborating with denials and variance teams to ensure prompt and accurate payments. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, and appealing claims when appropriate.
Essential Functions and Responsibilities Include the Following:
1. Understands and adheres to the client's performance standards, policies, and behaviors.
2. Completes review of third-party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances.
3. Processes patient and insurance refunds.
4. Review open accounts for reconciliation and the next steps to resolve open balances.
5. Review cases with provider representative liaison to ensure escalation and processing of outstanding balances.
6. Contact payors and patients as needed to resolve open balances and account issues.
7. Responsible for reviewing assigned work queues and ensuring all accounts are worked timely, especially high dollar and aged accounts.
8. Review correspondence for appropriate action to resolve accounts.
9. Assure clear and concise notes within the EMR for all transactions.
10. Completes associated actions within the EMR, such as insurance updates, adjustments, and allowances as needed.
11. Escalates issues to management and provider representatives regarding incorrect payer processing, contract issues, and/or trends.
12. Communicate with third-party representatives, relaying issues and discussing payment expectations.
13. Take appropriate actions to resolve issues that result in payment and/or complete closure of insurance balance.
14. Assure payor plan types and policy numbers are updated accurately within the EMR.
15. Collaborates with teammates and vendors as needed to reconcile and resolve outstanding accounts.
16. Review of claims to ensure payers process claims timely and in accordance with contract provisions.
17. Responsible for timely completion of projects and tasks as assigned by management and feedback on outcomes.
18. Responsible for ensuring productivity measures are being met daily.
19. Performs all other related duties as assigned.
20. HBI certification required.
Requirements:Education & Experience Requirements
- High School Diploma or GED required.
- 2-5 years previous patient accounting experience (hospital) preferred.
- Knowledge of medical terminology required.
- Familiarity with electronic medical record system, EPIC preferred.
- Proficiency with Microsoft Office/Excel, including PIVOTS and vlookup, is required for the intermediate level.
- Must be detail-oriented, problem-solve, multi-task, and perform various duties on demand.
- Certified Patient Financial Services Specialist (CPFSS) certificate required.
- Ability to cooperate with others.
- Must be able to speak, write, understand, and communicate in English.
- Effectively communicate with internal and external customers.
- Retains composure under stress.
- Integrity to handle the confidential aspects of work.
Physical/Mental Demands/Requirements & Work Environment
- May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital's SDS (Safety Data Sheet) database and may be accessed through the hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc.
- Must be able to remain stationary 50% of the time.
- The person in this position must occasionally move about inside the office to access file cabinets, office machinery, etc.
- Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.
- The person in this position will need to communicate with insurance plans and patients who may have questions. They must be able to exchange information in these situations accurately.
Primary Population Served
This position served all populations.
The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the client's needs.