Insurance Follow-up Denial Specialist I

Role Overview

• Protects the financial standing of Optim Health by performing functions related to the billing, coding verification, collection, payment, and customer service for all payer and patient accounts.
• Under general supervision, is responsible for processing insurance and billing insurance in a timely manner.
• Reviews assigned electronic claims and submission reports.
• Resolves and resubmits rejected claims appropriately as necessary.
• Works closely with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services departments to resolve outstanding claim errors by obtaining necessary information for accurate billing.
• Processes daily error logs, stalled reports, aging claims, and any ah-hoc reports.
• Addresses claim issues from insurance companies requesting additional information and/or checking status of billings.
• Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
• Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate.
• Sends initial or secondary bills to Insurance payers.
• Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary.
• Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager.

Requirements

• Able to work with advanced billing procedures.
• Able to prioritize and multitask based on volume of work within specific deadlines.
• Knowledge of the Revenue Cycle and the links between departments: Charge Capture, Patient Access, HIM, Coding, and Patient Financial Services.
• Working knowledge involving coverage, payment, compliance, and basic billing rules for Government and Managed Care payers.
• Uses discretion when discussing personnel/patient related issues that are confidential in nature.
• Ability to give and follow written and verbal directions.
• Working knowledge of personal computer applications and proficient in word, excel and power point applications. Self-motivator, quick thinker, communicates professionally and effectively in English, both verbally and in writing.
• Ability to work with all departments and all levels of management.
• One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management.
• High school diploma or GED.

Benefits

• Adheres to all company policies and procedures.
• Adheres to Optim Health Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.