Insurance Follow-up Specialist

Omega • Boca Raton, FL

4d • Remote

About The Position

Under limited supervision, the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in filing insurance claims, determining correct reimbursements/adjustment/write-offs, and denial management. They also analyze plans to determine which benefits are covered, submit secondary insurance claims, generate patient statements, and follow-up on those submissions.

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 and experience with standard office software products.
• High School diploma or equivalent.
• Skill in operating a personal or company owned computer and utilizing a variety of software applications is essential.
• 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.

Nice To Haves

• 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.

Benefits

• Equal Employment Opportunity: Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.
• Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at [email protected].

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED