Sr. Insurance Follow-up Representative

Catholic Health•Melville, NY

2d•$27 - $32

About The Position

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! The Sr. Insurance Follow-Up Representative will be responsible for assisting with the daily management of both the claims and follow up teams. The core responsibilities are to track and trend issues reported by the teams. The Sr. Representative will need to have knowledge of the claims process as well as follow up procedures. All job functions are required to be completed with a minimum number of errors and are subject to routine quality reviews.

Requirements

High School diploma or equivalent required.
EPIC experience required
5+ years’ experience in healthcare insurance billing, knowledge of third party insurance in regards to plan types (HMO/PPO/POS and Indemnity) required
Attention to detail – ability to maintain speed while upholding accuracy
Knowledge of CPT, ICD-9 and basic medical terminology required
Ability to perform analytics on issues and report on A/R trends
Skilled in Microsoft Office products. Word, Excel, and Power Point will be used daily
Ability to communicate clearly and effectively both verbally and written with a wide range audience
Needs to work independently and take initiative
Time management is a key function to being successful in this role
Must be organized and able to multi task
Ability to speak in front of large groups in person and on camera
Five years of Physician Billing experience, including follow up, required.

Responsibilities

Investigate claim status with insurance carriers, correct and resubmit denied claims
Using electronic accesses (Insurance carrier websites, Onbase, banking websites) to troubleshoot problems identified by the team
Learn computer applications as they relate to denial management systems
Assist in Staff training, creating educational presentations in Power Point and job aids
Assisting in developing and implementing new policies and procedures
Assist in preparing for team and departmental meetings agendas and minutes
Occasionally run team meetings or touchbases, meet with management from other teams to resolve issues
Assist in drafting department appeal letters and appeals processes
Preparing monthly productivity reports and spreadsheets for leadership
Review and approve or decline adjustments requested by the team, provide monthly totals on declined adjustments and education to team members with a high percentage or errors
Complete quarterly audits for productivity and accuracy for all team members and then present findings to the employee
Complete monthly audits on automated adjustments, provide feedback on any errors
Complete weekly audits of all paper claims, and provide updates to team members not following proper workflows
Maintain various tracking documents for issues and updates that will be reviewed by management
Sit in on employee reviews and write ups as needed
Counsel employees struggling with productivity and provide tips and tricks
Maintain acceptable work volume per day
Other duties as assigned by Supervisor, Manager or Director