Insurance Claims Representative

Under general supervision, an AR Account Follow-Up Specialist is responsible for account follow-up for all assigned accounts, resolving billing problems and answering patient inquiries. Uses collection techniques to keep accounts receivable current including monitoring for delinquent payments. The Account Follow-Up Specialist will review insurance claims and take appropriate action including completion of submissions, reconsiderations, appeals, and denial management to ensure payment is received timely.

• Performs audits of patient accounts to ensure accuracy and timely payment.

• Follows up on insurance billing to ensure timely receipt of payments.

• Demonstrates the ability to deal with patients and insurance companies regarding sensitive financial matters and recapture unpaid balances.

• Receives and resolves patient billing complaints and questions; initiates adjustments as necessary; follows up on all zero payment explanations of benefits and exercises all options to obtain claim payments.

• Reviews credit balance reports for correct recipient of refund.

• Performs reconciliation of refund accounts; attaches documentation and forwards to supervisor to process refund checks.

• Identifies problems on accounts and follows through to conclusion.

• Responds to insurance companies requests for information in a prompt and professional manner.

• Reviews EOBs to ensure proper reimbursement of claims and reports any problems, issues, or payor trends to supervisor.

• Prepares write-off requests with appropriate documentation and submits to supervisor.

• Processes insurance/patient correspondence.

• Works with provided aging to monitor patient account aging and follows up appropriately.

• Maintains confidentiality in regard to patient account status and the financial affairs of clinic/corporation.

• Other relevant duties as assigned

• Demonstrated knowledge of the federal, state, and local regulatory requirements around medical billing and coding as well as CMS and payer regulations.

• Ability to work independently.

• Able to manage multiple projects at once working efficiently and effectively under tight deadlines.

• Experience with oncology billing experience highly desirable.

• High school diploma

• 1 plus years of experience

• Experience in medical billing /insurance processing and balancing accounts