Insurance Claims Representative

Summary: Under general supervision, an AR Account Follow-Up Specialist is responsible for account follow-up for all assigned accounts, resolving billing problems and answering patient inquiries. Uses collection techniques to keep accounts receivable current including monitoring for delinquent payments. The Account Follow-Up Specialist will review insurance claims and take appropriate action including completion of submissions, reconsiderations, appeals, and denial management to ensure payment is received timely.

Essential Duties and Responsibilities: Performs audits of patient accounts to ensure accuracy and timely payment. Follows up on insurance billing to ensure timely receipt of payments. Demonstrates the ability to deal with patients and insurance companies regarding sensitive financial matters and recapture unpaid balances. Receives and resolves patient billing complaints and questions; initiates adjustments as necessary; follows up on all zero payment explanations of benefits and exercises all options to obtain claim payments. Reviews credit balance reports for correct recipient of refund. Performs reconciliation of refund accounts; attaches documentation and forwards to supervisor to process refund checks. Identifies problems on accounts and follows through to conclusion. Responds to insurance companies requests for information in a prompt and professional manner. Reviews EOBs to ensure proper reimbursement of claims and reports any problems, issues, or payor trends to supervisor. Prepares write-off requests with appropriate documentation and submits to supervisor. Processes insurance/patient correspondence. Works with provided aging to monitor patient account aging and follows up appropriately. Maintains confidentiality in regard to patient account status and the financial affairs of clinic/corporation. Other relevant duties as assigned. Demonstrated knowledge of the federal, state, and local regulatory requirements around medical billing and coding as well as CMS and payer regulations. Ability to work independently. Able to manage multiple projects at once working efficiently and effectively under tight deadlines. Experience with oncology billing experience highly desirable.

Requirements: High school diploma. 1 plus years of experience. Experience in medical billing /insurance processing and balancing accounts.