Insurance Follow up and Denials Rep

POSITION SUMMARY: Physician Services - Collector is responsible for Collections and Denial Management ensuring the appropriate action is taken on assigned accounts in a timely manner resulting in a positive resolution for Medicare, Medicaid, and all third-party payors as assigned. # JOB SPECIFICATIONS: # Education:## Minimum Required: High school diploma or equivalent or two (2) years of relevant experience Preferred: N/A # Experience: Minimum Required: One (1) year in Epic Professional Billing or equivalent physician patient accounting software experience Preferred: Two (2) years of experience in a healthcare setting, particularly in physician billing, collections, payment processing, or denial management preferred Strong financial or clerical experience License/Certification: Minimum Required: N/A Preferred: Certification in billing and/or coding # Special Skills/Training: Minimum Required: Must have basic computer skills Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes Hospital and professional billing processes and reimbursement Third-party contracting Insurance protocols, delay tactics, systems, and workflows ERISA guidelines for denials and appeals Regulations related to denials and appeals Experience with Epic, or equivalent EMR software Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change Possesses efficient time-management skills and proven ability to multitask under tight deadlines Demonstrates excellent customer service skills Effective writing and communication skills Strong comfort level with computer systems # Reporting Relationships: Does this position formally supervise employees? No # JOB STANDARDS:### Account Follow Up# Initiates next steps on accounts. Conducts relevant research to resolve claims including denials by completing reconsiderations and appeals, including assessing medical records, complete and accurate documentation, tracking, responding to and resolving for all assigned payers. Demonstrates initiative by collaborating with internal departments and external organizations to resolve reimbursement issues and be able to make recommendations and communicate trends to leadership. Demonstrates basic knowledge of hospital billing for Provider-based billing research/denials. Verify and update insurance coverages, as necessary. Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement. Monitors no response and denied claims for trends to identify root causes and reports findings to leadership. Analyzes EOBs to ensure proper reimbursement. Reviews posted payments and adjustments to ensure accuracy. Demonstrates basic knowledge of CPT and diagnosis coding. Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management. Quality and Productivity Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignments. Maintains Quality by effectively and accurately documenting all activity on the patient account. Displays efficient time-management skills. Maintains inventory to remain current without backlog while achieving productivity and quality standards. #Compliance Maintains knowledge of current payer guidelines and reimbursement policies while demonstrating comprehension of the techniques, policies, and procedures necessary to perform position responsibilities. Acts in accordance with LCMC#s mission and values, while serving as a role model for ethical behavior. Observes best practice processes in billing, follow-up, and customer service activities. Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines. Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare, Medicaid, and all third-party payor requirements as well as general revenue cycle processes. Adaptability and Professionalism Demonstrates the ability to make sound and timely decisions by reasonably evaluating information and taking appropriate actions. Willing to flex work assignments. Supportive of the department and LCMC goals and values. Receptive to constructive criticism. # The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position. # LCMC is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, disability status, protected veteran status, or any other characteristic protected by law.#

POSITION SUMMARY:

Physician Services - Collector is responsible for Collections and Denial Management ensuring the appropriate action is taken on assigned accounts in a timely manner resulting in a positive resolution for Medicare, Medicaid, and all third-party payors as assigned.

JOB SPECIFICATIONS:

Education:

Minimum Required:

High school diploma or equivalent

or two (2) years of relevant experience

Preferred: N/A

Experience:

Minimum Required:

One (1) year in Epic Professional Billing or equivalent physician patient accounting software experience

Preferred:

Two (2) years of experience in a healthcare setting, particularly in physician billing, collections, payment processing, or denial management preferred

Strong financial or clerical experience

License/Certification:

Minimum Required: N/A

Preferred:

Certification in billing and/or coding

Special Skills/Training:

Minimum Required:

* Must have basic computer skills

* Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes

* Hospital and professional billing processes and reimbursement

* Third-party contracting

* Insurance protocols, delay tactics, systems, and workflows

* ERISA guidelines for denials and appeals

* Regulations related to denials and appeals

* Experience with Epic, or equivalent EMR software

* Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change

* Possesses efficient time-management skills and proven ability to multitask under tight deadlines

* Demonstrates excellent customer service skills

* Effective writing and communication skills

* Strong comfort level with computer systems

Reporting Relationships:

Does this position formally supervise employees? No

JOB STANDARDS:

Account Follow Up

* Initiates next steps on accounts. Conducts relevant research to resolve claims including denials by completing reconsiderations and appeals, including assessing medical records, complete and accurate documentation, tracking, responding to and resolving for all assigned payers.

* Demonstrates initiative by collaborating with internal departments and external organizations to resolve reimbursement issues and be able to make recommendations and communicate trends to leadership.

* Demonstrates basic knowledge of hospital billing for Provider-based billing research/denials.

* Verify and update insurance coverages, as necessary. Communicates with payers on outstanding claims, resolves payment variances and achieves timely reimbursement.

* Monitors no response and denied claims for trends to identify root causes and reports findings to leadership.

* Analyzes EOBs to ensure proper reimbursement. Reviews posted payments and adjustments to ensure accuracy.

* Demonstrates basic knowledge of CPT and diagnosis coding.

* Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management.

Quality and Productivity

* Maintains responsibility for accurate and timely completion of daily follow-up or denial account assignments.

* Maintains Quality by effectively and accurately documenting all activity on the patient account.

* Displays efficient time-management skills.

* Maintains inventory to remain current without backlog while achieving productivity and quality standards.

Compliance

* Maintains knowledge of current payer guidelines and reimbursement policies while demonstrating comprehension of the techniques, policies, and procedures necessary to perform position responsibilities.

* Acts in accordance with LCMC's mission and values, while serving as a role model for ethical behavior. Observes best practice processes in billing, follow-up, and customer service activities.

* Adheres to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility-specific guidelines.

* Participates in staff training that aligns with recognized improvement opportunities and increase understanding of Medicare, Medicaid, and all third-party payor requirements as well as general revenue cycle processes.

Adaptability and Professionalism

* Demonstrates the ability to make sound and timely decisions by reasonably evaluating information and taking appropriate actions.

* Willing to flex work assignments.

* Supportive of the department and LCMC goals and values.

* Receptive to constructive criticism.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.

LCMC is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, disability status, protected veteran status, or any other characteristic protected by law.