Insurance/Patient Billing Follow-Up

Sante Health•Fresno, CA

About The Position

Sante Health System is hiring a full-time Insurance/Patient Follow-Up professional responsible for insurance and patient balance follow-up, aging reports, and customer service. The role reviews aged accounts receivable and takes appropriate action to help secure payment, including managing denials and correspondence, submitting corrected claims and tracers, contacting payers and patients, updating account information, and filing appeals or other requests. The employee maintains account aging in line with approved management and client goals, assists sites and patients with questions, arranges patient payment schedules, and documents work performed. The position requires strict confidentiality, professional customer service, adherence to work rules, and participation in required meetings and in-services. Other related duties may be assigned by the manager. Sante Health System is a healthcare claims and billing management company serving multiple clients in Central California. Its services include billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing and communications, physician services, practice management, provider relations, quality improvement, and utilization management. The organization describes its culture as talented, driven, dedicated, innovative, and service-oriented, and offers competitive pay, benefits, and opportunities for advancement.

Requirements

High school diploma or GED certificate.
Knowledge of ICD-10, CPT, and HCPC coding.
Ability to provide professional customer service and to multitask, prioritize, and manage time effectively.
Excellent communication skills.
Knowledge of billing guidelines for Government, PPO, HMO, Workers’ Compensation, Medicare, Medi-Cal, non-contracted plans, and private pay.
Working knowledge of billing regulations for PPO, HMO, Workers’ Compensation, and Government payers.
Knowledge of patient confidentiality regulations.
Professional telephone etiquette.
Maintain strict confidentiality.

Nice To Haves

Two years of medical billing experience preferred.

Responsibilities

Review and analyze aged accounts receivable and determine appropriate steps to help ensure payment.
Review and respond to denials and correspondence.
Submit corrected claims or tracers; add or remove modifiers and diagnoses, and add informational comments as needed.
Contact patients when additional information is needed and update patient demographic or insurance information as needed.
Contact payers to discuss claim status and request review; use web portals or phone calls to request expedited payment.
Attach supporting documentation to claims, such as medical records, primary EOBs, or authorizations.
File check tracers, appeals, reconsiderations, and reopening requests.
Review, analyze, and maintain account aging in accordance with approved management and client goals.
Assist sites and patients with questions and concerns and set up patient payment schedules.
Document all work performed as directed.
Notify management of concerns involving unusual payments or insurance claim processing.
Attend required meetings and in-services, follow safety and health work rules, maintain confidentiality, and perform other related duties as assigned.