Insurance Follow-Up Representative

Lehigh Valley Health Network•Allentown, PA

2d•Onsite

About The Position

Works collaboratively with department leadership to review and manage open Accounts Receivable, accurately documenting follow-up activities resulting in the resolution of underpayments and denials. Conducts root cause analysis of denials and takes the action necessary to resolve the denial escalating accounts to management that need to be submitted to the provider representative for contracting action. Identifies denial and underpayment trends that require computer system modifications and recommends necessary to implement corrective action. Prepares reports for meetings with provider representative and senior leadership, as required.

Requirements

High School Diploma/GED
2 years of professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field.
Excellent follow-up and verification skills.
Excellent verbal and written communication skills.
Knowledge of insurance contracts, and regulations.
Proficient with Microsoft Excel, Word, and PowerPoint applications.
Strong analytical, mathematical and organizational skills.
Successful Completion of DOE and Revenue Cycle Education Training within 3 months of hire.

Nice To Haves

Associate’s Degree in Health Care Science, Business or related field.
CPAT - Certified Patient Accounting Technician - State of Pennsylvania

Responsibilities

Demonstrates knowledge of insurance carrier reimbursement requirements to evaluate underpayments that are related to insurance carrier clinical and payment policies.
Demonstrates the ability to apply LVHN insurance contracts terms to claim payment reviews and the ability to determine if the source of an underpayment is related to a contract management discrepancy, an underpayment, or a line item denial.
Conducts a root cause analysis of denials, taking the appropriate corrective action as required, escalating denial trends to management, and routing denials to the appropriate area for resolution.
Calculates and submits adjustment and refund requests utilizing the appropriate adjustment code, refund reason, and clearly documents the account history.
Identifies the patient out of pocket expense related to non-covered services, co-pays, deductible, and co-insurance allocating the patient responsibility to the patient within the timely filing limit.
Demonstrates knowledge of and compliance with established organizational and departmental policies, procedures, objectives and goals.
Works collaboratively with management to establish issue logs and account examples for meetings with the insurance carrier provider rep.
Responds and reviews all emails and correspondence within 24-48 hours, manages mail received from patients and insurance carriers for appropriate distribution.