Patient & Insurance Account Resolution Specialist

Description

• →Answering inbound calls from patients and addressing any inquiries, concerns, or requests with empathy and professionalism.
• →Assisting patients with insurance inquiries, claims, and billing matters.
• →Providing information about medical procedures, services, and general healthcare inquiries.
• →Documenting patient interactions and updating relevant systems according to established guidelines.

• →Conduct detailed analysis and follow-up on outstanding government insurance claims to support timely and accurate resolution in accordance with payer guidelines.
• →Communicate with insurance carriers, patients, and other appropriate parties to  investigate and resolve outstanding accounts.
• →Research and resolve claim denials, rejections, underpayments, and payment delays.
• →Initiate appropriate billing corrections, appeals, resubmissions, and follow-up activities.
• →Prepare and submit required claim documentation, which may include EOBs, itemized statements, medical records, and other supporting documentation.
• →Respond to payer and patient inquiries regarding outstanding or delinquent claims.
• →Utilize payer portals, Electronic Health Records (EHR), patient accounting systems, and other available technology to investigate claim status and manage follow-up activities.
• →Accurately document account activity, communications, claim status, follow-up actions, and resolutions.
• →Identify billing or claim issues requiring corrective action or escalation.
• →Recognize trends in denials, underpayments, or payment delays and communicate  findings that may support process improvements.
• →Maintain  compliance with privacy requirements, payer guidelines, government requirements, client requirements, and company policies.
• →Organize and prioritize daily account inventory in a fast-paced, high-volume environment.
• →Consistently meet or exceed established productivity, quality, documentation, and account-resolution standards.
• →Participate in special projects and additional assignments as requested by management.

Following successful completion of the required government background and clearance process, the Specialist will transition to the Government Insurance Follow-Up team.

• Previous healthcare collections, medical billing, patient account resolution, insurance follow-up, claims, call center, or healthcare customer service experience preferred.
• Previous experience working with commercial, third-party, Medicare, Medicaid, or other government insurance claims is preferred.
• Experience investigating unpaid or underpaid medical claims is a plus.
• Direct insurance follow-up experience is not required for associates who demonstrate the aptitude and ability to successfully complete required training 

• High school diploma or equivalent.
• Must be a United States citizen.
• Must possess and be able to provide a valid REAL ID-compliant state-issued driver's license or identification card as primary identification for the required background process.
• Must be willing and able to complete required fingerprinting.
• Must successfully complete all required background investigation and identity-verification processes including going to your local VA office to complete the background investigation process.
• Must be eligible to obtain and maintain any government-required credential, including a Personal Identity Verification (PIV) card.
• Must promptly provide requested documentation and information necessary to complete the background and clearance process.
• The background and clearance process may take up to five months.