PB Denials & Follow up Rep

Ochsner Health • New Orleans, LA

2d

About The Position

This position is primarily responsible for resolving outstanding insurance account receivables through collection and billing activities. The representative communicates with government and commercial payors, clients, reimbursement vendors, patients, and other external resources to support account resolution and payment. The role includes researching accounts, verifying insurance and demographic information, following up on claims, appealing denials, and keeping current with payor guidelines. It also identifies account issue trends and reports them to a leader with recommendations for system improvements or edits.

The position requires compliance with applicable federal, state, and local laws, accreditation standards, and regulatory requirements. The incumbent must follow the employer’s Compliance & Privacy Program and Standards of Conduct, including reporting suspected unethical conduct, safety concerns, privacy issues, and other compliance-related matters. The role is classified as Light Work. Routine duties involve no exposure to blood, body fluids, or tissue and do not include emergency care or first aid. Healthcare-setting exposure to hazardous medications or waste may occur, with risk varying by job duties.

Requirements

• High school diploma or equivalent.
• At least 1 year of related experience in a hospital, clinic, medical office, business services/revenue cycle, front-line registration, financial counseling, banking, or customer-service-related job.
• Computer skills and dexterity for data entry and retrieval of job information.
• Effective verbal and written communication skills, including the ability to present information clearly and professionally to people at varying levels throughout the patient-care process.
• Proficiency with Windows-style applications, keyboard, and software packages specific to the role.
• Strong interpersonal skills.
• Ability to multitask.
• Ability to perform effectively in a fast-paced, changing environment.
• Ability to remain calm and professional in high-pressure or stressful patient financial and medical conversations.
• Reliable transportation to travel to other facilities to provide coverage as needed.

Nice To Haves

• Associate degree or bachelor's degree.
• Prior experience working with the EPIC system.

Responsibilities

• Research accounts using internal or external resources, including phone calls and payor websites, to determine account status and obtain payment.
• Verify or update insurance and demographic information to resolve barriers to payment.
• Follow up with payors and check claim status as needed during the payment process.
• Appeal denials and determine when appeals should be sent for further research or review.
• Maintain knowledge of differing payor guidelines using resources such as department meetings and payor website updates.
• Identify trends causing issues on assigned accounts and report them to a leader with recommendations for system improvements or edits.
• Perform other related duties as required.
• Remain knowledgeable about applicable laws, accreditation standards, and regulatory requirements, and ensure compliance.
• Report known or suspected unethical conduct, patient or employee safety concerns, privacy issues, and other compliance-related concerns.

What This Job Offers

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