Insurance Follow-up Specialist

Omega Healthcare Management Services•Boca Raton, FL

1d•Remote

About The Position

This role involves working with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues. The specialist will analyze claims (denial/non-denial) in practice management systems and internal systems, directing them toward resolution (Payment, Adjustment & self-pay). Key responsibilities include technical billing and denial follow-up on assigned payer claims, calling payers to resolve claims, identifying potential process improvements, and participating in training sessions to enhance knowledge of Revenue Cycle Management (RCM) processes. The role also requires resolving complex patient account issues, identifying and escalating complex payer issues, maintaining knowledge of client policies, following workflow documentation, and maintaining quality standards. The specialist will assist management with priority reports, maintain accurate records, and mentor new employees. Duties must be performed in compliance with company policies, including HIPAA and compliance regulations.

Requirements

Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing.
Must have industry knowledge of guideline requirements for Medicaid, Medicare, commercial payors and HIPAA.
Minimum 2-3 years’ experience in Denials Management/Collections/AR Follow-up.
Experience with standard office software products.
High School diploma or equivalent.
2 years of healthcare experience
2 years of denials and AR follow up
Proficient with Outlook and MS teams

Nice To Haves

Ability to prioritize and multi-task in a fast-paced, changing environment.
Demonstrate ability to work in all work types and specialties.
Demonstrate ability to self-motivate, set goals, and meet deadlines.
Demonstrate leadership, mentoring, and interpersonal skills.
Demonstrate excellent presentation, verbal, and written communication skills.
Ability to develop and maintain relationships with operations business partners by building personal credibility and trust.
Maintain courteous and professional working relationships with employees at all levels of the organization.
Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.
Demonstrate excellent analytical, critical thinking and problem-solving skills.
Manage the Individual KRA’s as per the provided metrics.
Meet the productivity and quality targets of clients within the stipulated time.
Ensure timely follow-up on pending claims and prepare and maintain individual status reports.
Skill in operating a personal or company owned computer and utilizing a variety of software applications is essential.
The use of a second monitor is required.

Responsibilities

Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
Analyze claims (denial/non-denial) in practice management systems, internal system and direct toward resolution (Payment, Adjustment & self-pay).
Technical billing and denial follow-up on all assigned payer claims.
Call Payer (Insurance/ third parties) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay).
Identify potential process improvements, trends, issues and escalate to Supervisor.
Be part of initial and all ongoing training sessions to enhance knowledge of RCM processes.
Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account transactions.
Identify trends/payer issues and escalate complex payer issues to the Supervisor, as necessary.
Maintain a working knowledge of client policies and procedures.
Follow the Workflow documentation like SOP’s.
Update tracker, Issue Log and Trend logs.
Maintain quality standards as determined by management.
Assist the Manager or Supervisor in working priority reports promptly, effectively, and efficiently.
Maintain accurate records within a collections database.
Be a mentor to new employees and assist in their training and development.
Perform other duties as directed.
Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.