Medical Billing​/AR Representative

The Insurance Follow-Up Representative reviews and researches unpaid claims in accordance with contracts and policies in order to achieve maximum reimbursement. The core responsibilities will include: identifying unpaid claims through reports and dashboards; reviewing submitted claims for complete information, correcting and completing claims and/or forms as needed; addressing denial letters and insurance medical records requests needed for claims processing; and resubmitting claims returned to provider/subscriber if additional information in needed.

Additional follow-up responsibilities include: direct follow up with patient when required; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general patient phone inquiries including patient payments, then recording the results in the practice management system.

• High school diploma or an equivalent combination of education and experience.
• Associate degree or higher in coding or health information management, accounting or business administration highly desired.
• Past work experience of at least one year within a healthcare setting, an insurance company, managed care organization or other financial service setting, performing medical claims processing, patient financial counseling, coding and/or claims follow up is required
• Knowledge of insurance and governmental programs, regulations and billing processes (e.g., CMS, Anthem, UHC, etc), managed care contracts and coordination of benefits is required.
• Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are required.
• Excellent communication (verbal and writing) and organizational abilities. Interpersonal skills are necessary in dealing with internal and external customers.
• Accuracy, attentiveness to detail and time management skills are required.

• Knows, understands, incorporates, and demonstrates the OSNI Core Mission, Vision, and Values in behaviors, practices, and decisions.
• Performs all follow-up functions, including the investigation of underpayments, payment delays resulting from denied, rejected and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner. These functions will be in coordination with the Business Office team.
• Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Billing Manager.
• Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions.
• Proactively follows-up on delayed payments by contacting patients and 3rd party payers, and supplying additional data, as required.
• May perform financial counseling activities, including but not limited to: discussing balances with patients, setting up payment plans, explaining statements and insurance processing. Counsels patient/guarantor on patient's financial liability, third party payer requirements.
• Counsels patient/guarantor of payment plan options and establishes appropriate plan.
• Investigates No Fault and Workers' Compensation cases, retrieving police report and insurance information, as required.
• Determines and manages proper course of action for optimal reimbursement of healthcare charges.
• Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect; and
• Updates and refiles claim forms in a timely, accurate manner.
• Responds to patient and 3rd party payer inquiries (telephone, fax, mail and web-based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution.
• Communicates with physicians and their office staff, Patient Access, Medical Records/Health Information Management, Utilization Review/Case Management,…