PB Denials & Follow up Rep

Ochsner Clinic Foundation • New Orleans, LA

3d

About The Position

This role is primarily responsible for resolving outstanding insurance account receivables. The position performs collection and billing activities related to account resolution and communicates with government and commercial payors, clients, reimbursement vendors, patients, and other external resources. The role includes researching account status, addressing barriers to payment, following up on claims, and appealing denials. Employees are expected to comply with applicable laws, accreditation standards, regulatory requirements, and the employer’s Compliance & Privacy Program and Standards of Conduct. The role is classified as Light Work and involves no routine exposure to blood, body fluids, or tissue, though the healthcare environment may present a risk of exposure to hazardous medications or waste. Reliable transportation is required to travel to other facilities as needed.

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, and/or customer service role.
• Computer skills and dexterity for data entry and retrieval of required 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 use, and software packages specific to the role.
• Strong interpersonal skills.
• Ability to multitask and 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 fill in as needed.

Nice To Haves

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

Responsibilities

• Research accounts using internal and external resources, including phone calls and payor websites, to determine account status and obtain payment.
• Verify and update insurance and demographic information to resolve barriers to payment.
• Follow up with payors and check claim status throughout the payment process as needed.
• Appeal denials and determine when appeals should be sent for further research or review.
• Maintain knowledge of differing payor guidelines through department meetings, payor website updates, and other resources to support accurate reimbursement.
• 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 federal, state, and local laws, accreditation standards, and regulatory requirements, and ensure compliance.
• Immediately report known or suspected unethical or questionable conduct and patient or employee safety, privacy, or other compliance concerns.

What This Job Offers

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