Account Follow-Up Representative II

Responsibilities

• Timely follow-up on hospital patient accounts outstanding for insurance payment, including verifying claim payment status, rebilling to the patient's insurance, prorating to the correct financial class, and documenting resolution steps
• Work an average of 40-50 accounts per workday for assigned payors
• Work assigned payor denials and zero-dollar pay reports within 24 hours of receipt
• Gather demographic, clinical, medical record, authorization, and insurance information needed to pay outstanding medical claims and update patient information in applicable systems
• Prioritize responsibilities and manage time effectively
• Analyze and help resolve denial and variance trends and payor issues with other teams
• Prepare less complex claims for reconsiderations and appeals
• Assist leadership in managing assigned accounts receivable and resolving outstanding insurance balances at 90 days post-discharge
• Work closely with third-party payors to reach resolution on outstanding balances
• Provide education and training for new hires and assist less experienced representatives
• Perform research on patient accounts and route them through appropriate workflows
• Review and recommend account adjustments in accordance with payor, company, and client guidelines
• Participate in projects assigned by team leads or managers
• Partner with other teams on workflow and project issues
• Maintain quality management system procedures and meet applicable regulatory requirements
• Attend role-based education courses within the calendar year
• Assist with special projects and stretch assignments
• Accurately submit worked time by required deadlines
• Maintain knowledge of insurance payors and collection regulations
• Respond timely to emails, phone calls, voicemails, Microsoft Teams messages, and correspondence
• Follow HIPAA privacy and security requirements

Knowledge, Skills, and Abilities

• Knowledge of revenue cycle processes impacting insurance reimbursements
• Knowledge of insurance follow-up processes and healthcare reimbursement methodologies
• Proficiency with telephone systems for outbound and inbound calls
• Ability to access protected health information in accordance with departmental guidelines
• Skilled in accurate arithmetic computations
• Strong communication, judgment, tact, initiative, and resourcefulness
• Detail-oriented, organized, and able to multitask
• Ability to concentrate for long periods of time
• Ability to work independently and as part of a team
• Ability to build supportive relationships with peers, clients, partners, and executives
• Flexible, professional, and able to remain calm under pressure
• Able to learn new systems quickly and develop proficiency in a reasonable timeframe
• Able to understand oral and written directives

Training and Experience

• High school diploma or equivalent required
• 3+ years of experience in a related medical field
• Ability to follow directions and perform work independently according to department standards
• Emotional maturity and ability to function effectively under pressure
• Proficiency with Microsoft Office applications
• Customer service oriented

Other Requirements

• High-speed internet access with a minimum 300 Mbps download speed and unlimited data
• Smartphone for multi-factor authentication

Benefits and Perks

• Comprehensive medical, dental, and vision benefits
• 3 weeks of vacation plus 5 personal days
• Employee stock ownership
• RRSP program
• 401(k) with matching
• Community involvement opportunities
• Flexible work arrangements