Required:

• 1-3 years of Experience
• Willing to work On-Site
• Bachelor’s Degree

Skills:

• CLAIMS
• DENIALS
• MANAGEMENT
• BENEFITS
• INSURANCE
• BILLING
• REVENUE
• CYCLE
• ACCOUNT REPRESENTATIVE

Duties:

• Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures
  Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes.
• Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates.
• Ensures that all accounts associated with that guarantor and payor relationship are resolved.
• Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance.
• Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager.
• Refers problem accounts to Sr. Rep, Team Lead or Manager prior to accounts becoming 60 days old.
• Documents the issues in detail and refers to Sr. Rep, Team Lead or Manager with a recommendation of action needed. Provides continual follow-up.
• Assists with special projects to ensure that collection, workqueue, and departmental goals are met.
• General knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations.
• The knowledge of how managed care plans work and the requirements for insurance coverage and benefits.
• Ability to communicate effectively both oral and written, good interpersonal skills; decision-making skills; professional courtesy; the ability to operate a PC and general office equipment.
• Account Representatives must have a strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations.
• Updated: Gov: Physician Revenue Cycle and Insurance Collections experience for government entities Traditional Medicaid and Managed Medicaid Plans is required and Out-of-State Medicaid is a plus. This includes appealing insurance claim denials, underpayments, and understanding root cause analysis of insurance-related activities.
• Billing and general pediatric facilities is a PLUS.
• Experience with larger facilities and have a track record of being able to adapt to both quality and productivity standards.
• Applicants who do not have physician insurance collections experience and a minimum of 2 years of current job history will not be considered.
• Experience with Excel and Epic is strongly preferred.
• Please note, while this is mostly a remote position, training will take place in the office for up to 8 weeks.
• Remote positions require adherence to the client’s telecommuting policy.