Follow-up Rep 1 - Waterbury Hospital : Job Details

SCOPE OF POSITION: The Follow Up Rep 1 position is responsible for the reimbursement of claims from various insurance companies and or government payers. The position will maintain proper follow-up on assigned accounts using department's collection guidelines, policies, procedures, government rules and regulations and managed care contracts. RESPONSIBILITIES:

• Responsible to assign accounts and meet department's productivity expectation.
• Monitors and/or follow-up accounts by using insurance company's web-portal and/or make telephone calls to assure timely resolution and accurate reimbursement.
• Responsible for identifying follow up problems and issues
• Contacts the insurance companies to inquire about denial reasons to ensure proper resolution is applied.
• Monitors and/or follows-up on accounts with precise documentation and calculations.
• Utilizes the previous documentation comments in order to follow up in the appropriate manner.
• Utilizes aging reports to monitor each account and resolves barriers to assure timely and correct payment
• Reviews remittance codes from EOB's and RA's to ensure appropriate payment or to identify denials or non-payment
• Works the current hospital information systems queues/processes set up for their specific assignment/payers as directed by Leadership.
• Refers all payer issues/problems to Leadership in a timely manner with specific examples.
• Responsible for complete, accurate, and timely documentation of all follow-up pertaining to the resolution of the account within the current hospital information systems patient financial record
• Performs other duties as assigned.

REQUIREMENTS:

• 1 year of recent hospital collections experience preferred but not required.
• Understanding of insurance terminology, Medicare and Medicaid guidelines, managed care payer contracts and contract language is preferred.
• Ability to perform complex mathematical calculations to adjudicate accounts appropriately.
• Ability to analyze and adjudicate complicated contractual arrangements
• Proficient with Microsoft Excel, Word, and PowerPoint applications
• Must demonstrate excellent communication skills while dealing with confidential financial matters