Insurance Follow Up Rep- Kelsey Seybold Admin Office

UnitedHealth Group•Pearland, TX

18h•$18 - $32

About The Position

The Insurance Follow-Up Representative works under the supervision of the Business Office Supervisor and handles physician billing and collection of third-party accounts receivable. The role uses medical software, the EHR, and payor websites to research assigned unresolved accounts, refile or appeal claims, submit medical documentation, monitor account status, and manage an inventory of more than $1 million in insurance receivables. The representative contacts internal and external parties to negotiate resolutions and responds to inquiries and correspondence from third parties and patients. The position requires analyzing, auditing, problem-solving, and reconciling accounts while following federal and state billing guidelines, contractual obligations, and department policies. The representative must work independently, remain composed, meet deadlines, and resolve issues in a fast-paced environment with frequent interruptions. Patient communications are conducted professionally and courteously, including explaining financial liability and noncoverage, processing payments, clarifying EOBs and physician-service statements, and arranging payment plans. The role emphasizes courteous, effective service and a positive patient experience.

Requirements

High school diploma or GED from an accredited program.
At least 3 years of current experience in healthcare billing and collections or a relevant healthcare setting using an accounting or healthcare computer system; alternatively, at least 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 and application of CPT and ICD coding.
Ability to interpret Explanation of Benefits (EOBs) and physician billing statements.
Demonstrated analytical and mathematical ability.
Excellent interpersonal communication skills and ability to communicate effectively orally and in writing with patients, physicians, management, and third-party representatives.
Ability to handle varied tasks with speed, attention to detail, and accuracy.
Ability to work independently, remain composed, meet deadlines, and analyze, research, and resolve problems in a fast-paced environment with frequent interruptions.
Professionalism and courtesy when communicating with patients and external contacts.

Nice To Haves

Associate degree in Business Administration or a related field, or successful completion of a Coding and Billing Certificate Program.
At least 5 years of experience in healthcare billing and collections or a relevant healthcare setting using an accounting or healthcare computer system in the area of specialty.
Epic Professional experience.
Billing experience and understanding of a variety of insurance plans.
Ability to access and retrieve information from the EHR.

Responsibilities

Work assigned work queues, including web-based work files, within filing and appeal deadlines.
Adjudicate rejected and unpaid claims under departmental policies and procedures; contact insurers about unpaid or non-rejected claims; research denials, obtain necessary information, correct transactions, and appeal as appropriate.
Meet established production and quality standards.
Identify payor reimbursement patterns and trends and alert management as needed.
Provide routine workflow training to new employees and assist Level I employees with denials, appeals, and timely account responses in areas of expertise.
Stay current on assigned payor guidelines and reimbursement policies and share relevant information with department management as needed.
Communicate with patients by incoming and outgoing phone calls to explain financial liability and noncoverage, process payments, clarify EOBs and physician-service statements, and establish payment plans according to department policies.
Perform other duties as assigned.
Research and monitor assigned unresolved third-party accounts, refile or appeal claims, submit supporting medical documentation, and track account status.
Negotiate appropriate resolutions and respond to inquiries and correspondence from third parties and patients.
Follow industry, federal, and state billing guidelines, contractual obligations, and department policies and procedures.