Insurance Follow Up Rep- Kelsey Seybold Admin Office

UnitedHealth Group•Pearland, TX

7h•$18 - $32•Onsite

About The Position

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. Position in this function is under the supervision of the Business Office Supervisor, the Insurance Follow-Up Representative is responsible for physician billing and collecting of third-party account receivables using their knowledge of medical software, the EHR, and multiple payors’ insurance websites to research accounts, refile or appeal claims, submit additional medical documentation and track account status by monitoring and analyzing assigned unresolved third-party accounts. The Representative is responsible for an inventory of over a $1M in insurance receivables. They will initiate contacts and negotiate appropriate resolution (internal and external) as well as receive and resolve inquiries and correspondence from third parties and patients. The ability to analyze, audit, problem solve and reconcile an account is critical to this position. Conducts duties in accordance with industry federal and state billing guidelines and contractual obligations and in compliance with department policies and procedures. Must demonstrate dependability and an ability to work independently. Must be able to retain composure, meet deadlines, and appropriately analyze, research, and resolve problems in a fast-paced environment with constant work-related interruptions. Professionalism and courtesy are expected when communicating with external contacts and patients to explain patient financial liability, advises of non-coverage, process payments and payment plans, clarify Explanation of Benefits and statement of physician services. Exhibits exceptional customer skills to provide the patient with a positive service experience.

Requirements

High School diploma or GED from an accredited program
3+ years of current experience in a health care billing and collection environment or relevant health care setting using an accounting/health care computer system; or 2+ years of related experience with preferred education
Working knowledge of major third party payers and their websites
Basic PC and Internet literacy
Medical Terminology, CPT & ICD coding application
Interpreting Explanation of Benefits (EOB’s), physician billing statements
Proven good analytical and mathematical ability
Proven excellent interpersonal communications skills and ability to communicate effectively both orally and in writing with patients, physicians, management, and third-party representatives
Proven ability to handle a variety of tasks with speed, attention to detail and accuracy

Nice To Haves

Associates degree in Business Administration or related field; or successful completion of Coding and Billing Certificate Program
5+ years experience in a health care billing and collection environment or relative health care setting using an accounting/health care computer system in area of specialty
Epic Professional Billing experience as is an understanding of a diversity of insurance plans
Epic Professional Billing
Ability to access and retrieve information from the EHR

Responsibilities

Works assigned work queues, to include web-based work files, within filing and appeal deadlines
Adjudicates rejected and unpaid claims in accordance with established departmental policies and procedures. Contacts insurance companies regarding unpaid or no reject claims. Researches denied claims to obtain necessary information, correct transactions as needed, and appeal appropriately
Meets established production and quality standards
Identifies payor reimbursement patterns and trends and alerts management on an as needed basis
Provides routine workflow training to new employees. Works in conjunction with Level I employees, responding in areas of expertise in order to assist in denials, appeals and timely responses to accounts needing additional attention
Maintains competency by staying abreast of assigned payor(s) guidelines and policies regarding reimbursement and shares this information with department management on an as-needed basis
Communicates with patients through incoming and outgoing phone calls to explain patient financial liability, advises of non-coverage, process payments, clarifies explanation of benefits and statement of physician services. Sets up payment plans for services following department policies. Exhibits exceptional customer skills to provide the patient with a positive service experience
Other duties as assigned