Reporting to the Team Leader of AR/FOLLOW-UP, the position will be responsible for all insurance follow-up from third party payers, to be responded to in a courteous, timely manner.
Representatives will process patient accounts to third parties and resolve accounts to a zero balance. Expertise in all third-party billing and contracted payment agreements. The account representative is required to have good writing skills, and ensure proper account documentation. Verbal communication required for relaying issues/concerns with problem accounts to supervisor and mangers.
- Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
- Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.
- Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts that are greater than 30 days old.
- Maintain accounts receivable detail by use of on-line system documentation.
- Reports productivity results daily to the AR supervisor.
- Maintains standards per payer for percentage accounts >90 days.
- Works minimum standard number of accounts per payer per day.
- Meets or exceeds collection goals by payer each month.
- Works all assigned accounts at least once every 15 or 30 days, depending on balance.
- Participates in educational activities and attends monthly department staff meetings.
- Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
- Other duties as assigned from time to time.
HS diploma or General Education Degree
Three to Five years’ experience in medical office billing preferred.
Knowledge of ICD-10 /HCPCS/CPT Coding
Basic Knowledge of third party insurance plans
Familiarity with medical terminology helpful.
- Must be able to communicate effectively when in contact with insurance carriers, third party payers and patients.
- Must be able to learn and understand patient accounting policies and procedures and how the Accounts Receivable computer system works.
- Must be able to use a computer, calculator, fax machine. Copier and other office tools efficiently to meet performance goals.
- Intermediate knowledge of Microsoft Word and Excel: and the ability to learn new programs and systems.
- Dependable in both production and attendance.
- General Supervision, functioning independently, referring unusual problems to supervisor.
Working Conditions and Physical Requirements
Physical Demand Category:
- Sedentary- Occasional lifting/pushing/pulling/carrying up to 5 pounds within 10 pounds’ maximum
This Job Will Require:
- Standing- Occasional
- Walking- Occasional
- Sitting- Continuous
- Bending- Occasional
- Squatting- Occasional
- Twisting- Occasional
- Reaching- Occasional
- Finger Dexterity- Continuous
- Repetitive Motion- Continuous
Working Environment Type:
- Business /General Office with cubicles
Work Environment and Exposures:
- Blood /body fluids- Rare
- Confined Space -Regular cubicles
- Heights- not applicable
- Loud Noise- occasional train
- Heat/Humidity – Rare
- Cold- Rare
- Chemicals- not applicable
- Fumes/gases- Rare
Audio-Visual and other demands:
This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees are required to follow any supervisory instructions and to perform duties as requested by the supervisor and /or other management personnel from time to time.
This job description is intended to describe the nature and level of work being performed by people assigned to this position. It is not to be construed as an exhaustive list of all responsibilities and duties required of the job incumbents. Upon review of the job description and requirements, I can perform the essential functions of the job with or without accommodation.