Hospital Insurance Follow Up Representative

Hospital Insurance Follow-Up Representative 





The Insurance Follow-up Representative position is responsible for all insurance follow-up on assigned accounts from the PAS management team.  The core responsibilities of an insurance follow-up representative include research, insurance billing and adjustment identification to ensure proper account resolution.  This position requires the ability to work independently, accomplish goals, excellent customer service and communication skills, creativity, patience and flexibility.  Insurance Follow-up Representatives rely on guidelines established by the organization to perform job functions and work under general supervision in a moderately fast paced environment.  Insurance Follow-up Representatives usually report to the department lead or supervisor.

 

EDUCATION & WORK EXPERIENCE:

High school diploma or equivalent.  A minimum of one year previous work experience as an insurance follow-up representative is required.  Must have full understanding of insurance follow-up processes (i.e. Billing, Collections, Managed Care, Medicare, Medicaid and Commercial Practices), and well-developed inter-personal skills.

 

 

REQUIRED JOB KNOWLEDGE & SKILLS:

· Excellent verbal and written communication skills

· Reliable attendance record

· Knowledge of EOBs, CPT & ICD-9 codes, HCFAs, UB92s, HCPCS, DRGs and authorizations/referrals

· Good problem solving skills

· Ability to learn / stay abreast of relevant policies

· Computer literate / able to use basic functions of a computer

· Ability to type a minimum of 30 wpm

· Detail oriented and well organized

· Outstanding listening skills

· Ability to perform under pressure in a calm manner

· Basic math skills

· High degree of accuracy

· Positive attitude

· Flexible

· Team player

 

 

CORE RESPONSIBILITIES & JOB FUNCTIONS:

Core responsibilities include but are not limited to the items listed below:

· Obtain Claim Status via the Telephone, Internet and/or Fax

· Review & Interpret Contractual Terms for Managed Care, Commercial, Medicare, Medicaid and Workers’ Compensation

· Obtain Supporting Documentation Regarding Insurance Follow-up Efforts

· Identify Contractual & Administrative Adjustments 

· Billing via Electronic & Hardcopy Submission