Triage Order Quality Associate II

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries.

The Triage Order Quality Associate Level II (TOQII) position is responsible for the accurate and timely work of filing insurance claims for Abbott Cancer Diagnostics. This role will demonstrate medical insurance knowledge by determining initial and/or ongoing eligibility, coverage, and related insurance reimbursement order details, including commercial, government, and all various plan coverage. This role will identify order and reimbursement deficiencies, route orders for appropriate actioning and assist with triaging, and document actions taken within the systems for claims lifecycle tracking.

This role will be responsible for claims escalations that TOQI are unable to resolve in addition to working "bulk" claim projects. This role will also support the broader activities of ensuring appropriate coverage by utilizing Epic, external portals, and other software, and communicate insurance information to ancillary departments and other teams within the reimbursement operations departments.

Location:

Remote, United States

Hours:

1st shift, business hours

• Independently determine initial or ongoing patient insurance eligibility verification; investigate and correct accounts within Epic, including updates to patient demographics, financial information, and guarantor information. Interact with various insurance companies and third-party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations. Research missing or erroneous information on accounts using various portals and other resources, including outreach and identification of unknown payors.
  
  Review and edit claims and appeals prior to submitting to the clearinghouse. Analyze, research, and resolve claim issues by applying federal, state, and payor rules and procedures with a high degree of independence. Monitor work queues (WQs) for claims requiring additional research and take appropriate action to move them toward resolution. Provide CRM support. Demonstrate an exceptional understanding of Claim Edit and Follow-Up WQs.
  
  Utilize OnBase to process documents specific to the TOQ department. Correct rejected claims from the claims scrubber, clearinghouse, or payor. Review explanations of payments, analyze denials, and complete appropriate resolution steps, including appealing, writing off, or sending statements. Validate new workflows resulting from product growth and maintain ownership of specific WQs until setup is validated and working effectively. Investigate payor underpayments.
  
  Follow up with payors via phone regarding unpaid and aging claims. Provide supporting documentation as needed by insurance payors. Perform accurate and timely write-offs after identifying uncollectible accounts, adhering to established policies and guidelines. Provide ad hoc support within the department as necessary, including special projects and support during outages or periods of high volume. Complete position responsibilities within appropriate time frames while adhering to established quality standards.
  
  Stay current with relevant medical billing regulations, rules, and guidelines. Maintain the strictest confidentiality and adhere to all HIPAA guidelines and regulations. Demonstrate excellent problem-solving abilities and organizational skills. Communicate effectively with all levels of staff through both…