INS FOLLOW UP REP- 1703

Artesia General Hospital•Artesia, NM

7d•$15 - $23•Onsite

About The Position

This position is responsible for answering phone calls, providing outstanding customer service to patients inquiring about their accounts, and confirming patient insurance eligibility and/or benefits. The role involves auditing charts for accuracy of billing/payment/income, correcting address information, and educating patients on services and payment methods. The position also assists with system implementations, training new employees, and ensuring timely follow-up on accounts to meet established payer guidelines and payment timeframes. A key aspect is managing accounts to ensure no more than 15% of A/R is over 90 days old and maintaining an account quality rate of at least 96%, with zero timely filing adjustments. The role participates in the appeals and denials process, works accounts requiring additional steps for payment, and addresses outliers and catastrophic claims. It requires reporting trends, strong attention to detail, effective communication, and utilizing billing system audit reports. The position maintains established productivity standards, uses electronic communication tools to resolve outstanding insurance balances, and provides feedback to management on trends. Claims are resubmitted accurately, and the ability to differentiate Explanation of Benefits is crucial for resolving outstanding balances. Patient contact may be necessary for balance resolution. Additional responsibilities include prompt response to emails and calls, exceptional interpersonal and organizational skills, and manual payment posting. The role supports the Business Office Lead/Supervisor/Manager/Director and performs other duties to ensure exceptional customer service. Awareness of age-specific, cultural, and spiritual practices, as well as functional status and physical needs of patients, staff, and visitors, is expected. Annual training and compliance with hospital policies are required.

Requirements

High school diploma or equivalent required.
1 - 3 years of experience in the healthcare setting (Hospital and/or medical office) working with insurance claims processing involving CPT, HCPCS, ICD-9CM, ICD-10CM and CMS regulations.
Familiarity with CMS1500 and UB04 claim form completion.
Strong analytical, oral, written communication skills.
Familiarity with health insurance and other third party billing practices and guidelines.
Proficient in Microsoft Word, Excel, Access, Outlook, and the like.
Must be able to assess situations, identify issues/problems and prioritize duties.
Reasoning Ability: Uses personal experience, knowledge and other outside resources to make logical decisions to solve problems.
Utilizes Time Management and Organization skills.
Strong attention to detail, is accurate and completes principle accountabilities timely.
Professionalism.
Understand medical terminology
Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.
Minimum 2 years of experience in the healthcare setting (Hospital and/or medical office) working with insurance claims processing involving CPT, HCPCS, ICD-9CM, ICD-10CM and CMS regulations.
Familiarity with CMS1500 and UB04 claim form completion.
Strong analytical, oral, written communication skills.
Familiarity with health insurance and other third party billing practices and guidelines.
Proficient in Microsoft Word, Excel, Outlook, and the like.

Nice To Haves

Bilingual in Spanish and English a plus.

Responsibilities

Answer phone calls
Provides outstanding customer service to patients inquiring about their accounts.
Confirms patient insurance eligibility and/or benefits.
Audits charts for accuracy of billing/payment/income.
Correct address information as required for guarantor, patient, insurance companies, employers etc. Communicate those changes as appropriate.
Discuss and educate guarantors and patients on various services offered by AGH and Clinics as well as methods of payment for those services including but not limited to Medicare, Medicaid, Insurance, Financial Assistance and other state and county assistance programs.
Assist with the implementation of potential new systems and process changes.
Assist with training new employees.
Ensure accounts are followed up timely (within established payer guidelines).
Follow up to ensure that accounts are paid within the established timeframes
Ensure that the account is properly paid per the payer contracts.
Ensure that no more than 15% of A/R is to be over 90 days old.
Maintain account Quality rate that is no less than 96%.
Timely filing adjustments are to be 0%.
Participate in the appeals and denials process to ensure claims are properly resubmitted and reprocessed for payment.
Work accounts identified through the contract management system that require addition steps to ensure proper payment.
Work outliers, catastrophic claims to ensure additional payment is received.
Report any noted trends in the follow up system or denied claims reports.
Utilize Audit Reports from billing system to ascertain proper receipt of claims to the appropriate payers.
Is able to maintain established productivity standards.
Utilize electronic, web based or telephone communication tools to resolve outstanding insurance balances.
Provide feedback to management/supervisor regarding identified trends in billing or non-payment of outstanding insurance balances.
Resubmit claims to insurance payers as appropriate.
Ensure resubmission of claim(s) is accurate by not resubmitting claims with the same problems repeatedly.
Be able to differentiate information on the Explanation of Benefits to determine next steps in resolution of outstanding balances.
Contact patient when need be to assist is resolving outstanding balances if required.
Prompt response to e-mail and telephone calls.
Input data from insurance remittance advices and patient payment batches into Patient Accounting System.
Assist Business Office Lead/Supervisor/Manager/Director as required or assigned.
Performs other necessary duties as required to meet the goal of providing exceptional customer service to the community and health system.
Demonstrate awareness of age specific, cultural and spiritual practices of patients, staff and visitors.
Complete Annual training/recertification as required.
Understands the functional status and physical needs of patients, staff and visitors.
Treat all customers, coworkers, medical staff and the communities we serve with integrity and service excellence at all times as measured by documented communications to the Department Director.
Abide by the policies of Artesia General Hospital related to compliance.
Attend departmental/team meetings as required.
Complete annual education and training requirements.
Treat all information and data within the scope of the position with appropriate attention to confidentiality, privacy, HIPAA and security policies/regulations.
Cooperate fully in all Risk Management, Quality Management, and Safety Activities and Investigations.