Follow-up Representative

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Follow-up Representative

Emeryville, CA

Hybrid: onsite at least 3 days/week for training, then onsite once a month.

• Epic Resolute Professional Billing experience (required).
• Experience in medical billing, with a preference for Professional Fee (Pro Fee) billing (required).
• Insurance claims follow-up experience/ Denial management experience (preferred).
• Familiarity with payer websites and payer provider services (required).
• Experience with Government Professional Fee (Pro Fee) billing.
• Knowledge of Medi-Cal managed care processes (preferred).

The Government, Commercial, Contract and Managed Care (CCMC) Units are responsible for the accounts receivable, billing, and follow-up of all government or commercial, contract and managed care payers. The units deal regularly with complex policy and procedural issues that involve contract compliance with regard to Medicare, Medi-Cal, CCS, HMO and PPO payers. It is the units' responsibilities to communicate and to coordinate throughout various UCSF Medical Center departments, including the UCSF billing agents to ensure the quality of the university's billing process.

Within these units, the Follow-Up Representatives are responsible for billing and follow-up of government, commercial, contract and/or managed care accounts receivables for MGBS clients. The incumbent demonstrates the ability to perform all aspect of billing and follow-up with quality. The incumbent's main task is to resolve all outstanding insurance accounts through constant communication with the payers (by phone or via web access), other MGBS units, UCSF clinical departments and billing agents.

When resolving the accounts receivables; the Follow-Up Representative must adhere to the MGBS SRG (Situation Response Guide) to ensure consistency with the follow-up and documentation processes and to maintain good quality work. The Follow-up Representative must meet minimum productivity standards and quality expectations of their units. The Follow-up Representative must attend and be engaged in unit and team meetings aimed at increasing knowledge.

The incumbent will utilize web based tools, including payor websites and the RMS website prior to calling payors. The incumbent will conform to all UCSF, MGBS, government and HIPAA policies and procedures.

• Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide).
• Make daily inquiries on unresolved invoices by phone or via the internet.
• Interpret account information and enter important details to provide an audit trail for further follow up.
• Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS.
• Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines:
  • CCI edits
  • UCSF Contract Report
  • Profee Grid
  • Medicare Fee Schedule
  • Cascading guidelines
  • CPT, ICD-10, HCPC, Medical Terminology Manuals.
• Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX.
• Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, and commercial insurance.
• Initiate Charge Correction request.
• Submit requests to department via RFI (Request for Information) process and review response for appropriate action.
• Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
• Complete and submit refund request with detailed back-up to the unit manager for approval.
• Effectively communicate with MGBS peers, payers, patients, UCSF departments Leads, Assistant Managers and managers.
• Utilize knowledge of various systems including, but not limited to:
  • Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government…