Insurance Recovery Representative

PFS Group•Houston, TX

4d•Remote

About The Position

Under the supervision of the Insurance Supervisor, the Insurance Recovery Representative is part of a specialized float team who assists projects with new or vulnerable inventory to quickly make measurable impacts on client metrics. They ensure the efficient operation and effective reimbursement of hospital or professional insurance claims by researching unpaid balances, correcting billing errors, writing and filing appeals, or submitting any other requirement to secure payment. They use their deep understanding of insurance carriers, and coding and billing guidelines to confidently handle a wide variety of account types. The Insurance Recovery Representative will thrive in varying EMR and Patient Accounting systems, and in dynamic environments.

Requirements

Experience with Epic Resolute (either HB or PB) required.
Two years of revenue cycle experience in Insurance Follow-Up or Denials.
Experience in hospital system settings with high claim volumes.
High school diploma or equivalent required.
Strong experience referencing payer portals, and payer billing and medical coverage policies.
Knowledgeable in insurance reimbursement methods and remit reason codes.
Outstanding listening, communication, problem-solving, and attention to detail.
Proficiency in Microsoft Office suite, with emphasis on Excel.
Ability to work well under pressure, shift focus quickly, and multi-task routinely.
HIPAA knowledge and compliance.

Nice To Haves

Experience with additional EMRs (Cerner, Meditech, etc.).
Knowledge of both hospital and physician billing guidelines.
General understanding of unique billing scenarios, to include Maternity/L&D, Fertility, Transplant, children’s Medicaid programs like Medi-Cal CCS or Texas Star, etc.

Responsibilities

Orients quickly to various Patient Accounting systems, with emphasis on Epic Resolute (HB and PB).
Works 100% of assigned inventory daily to meet client resolution targets, as part of a specialized recovery team.
Identifies root causes for denials or non-payment and investigates trends.
Makes accurate actions on accounts to achieve one-touch resolution wherever possible; requires little oversight in decision-making.
Interprets payment variances and payer guidelines to monitor for underpayment opportunities.
Facilitates patient outreach to resolve coverage discrepancies.
Places correct adjustments as needed to ensure balances are accurately documented.
Documents all follow-up activities thoroughly.
Works accounts spanning multiple states and multiple insurance payer types, to include government, commercial, and managed care plans.
Accurately follows client and department protocols, using resources available to work independently.
Recommends changes where needed.
Complies with all federal, state, managed care, and client compliance requirements
Meets all department performance requirements, to include productivity, quality, and attendance standards.
Performs other duties as requested in a team-oriented environment.