Start the day excited to make a difference...end the day knowing you did. Come join our team.
The Follow-Up Representative performs all duties associated with the timely, accurate follow-up of third party payers, patients or guarantors to facilitate effective reimbursement.
Essential Functions & Responsibilities:
Conducts follow-up inquiries with secondary payers and third party carriers by telephone and/or their websites within 15-30 days from final bill date. Performs subsequent inquiries to ensure receipt of claim and collect payments based on contract and non-contracted rates, as needed.
Reviews accounts with a balance for insurance payments and applicable contractual adjustments to determine whether the claim has been paid and if the payment amount was appropriate. Confirms whether a denial needs to be appealed and refers accounts to Supervisor for review as needed.
Analyzes claim rejections/denials; interpreting the rejection/denial reason code, working the technical denials, and referring clinical denials to Denials Management.
Re-bills claims, as needed, through the hospital billing system and documents the reason for the resubmission in the applicable financial system. Requests and gathers needed information (i.e. medical records, itemized statements) and forwards to the payer as requested.
Contacts patients with a minimum of 1 phone call and 2 letters for additional information to reprocess or appeal when claims remain unpaid.
Writes off accounts based on established guidelines, as appropriate.
Maintains knowledge of current payer submission guidelines and policy changes. Adheres to Federal regulations (HIPAA) and all third party payer guidelines and compliance requirements to ensure accounts are paid correctly.
Maintains productivity standards as established by management
Demonstrates knowledge of equipment and systems/technology necessary to complete duties and responsibilities.
Performs other duties as assigned.
Additional Responsibilities for Senior Follow-Up Representative:
Participates in the orientation and training of new staff. Provides feedback to leadership regarding team performance.
Monitors follow-up work queues for productivity and notifies leadership if there is a need for intervention or work reassignments.
Acts as a subject matter expert and assists team members with follow-up questions or issues.
Works with team members to identify information system issues, submit problem tickets, and ensure issues are resolved.
High School diploma or equivalent required.
One year healthcare follow-up experience required.
One (1) to two (2) years healthcare related experience required.
Additional Qualifications for Senior Follow-Up Representative:
Three years healthcare follow-up experience required.
Three (3) to five (5) years healthcare related experience required.
AAHAM Certified Revenue Cycle Specialist (CRCS) or related industry certification preferred.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
A Not-for-Profit Regional Healthcare System Dedicated to Excellence. From our humble beginnings in Fredericksburg, Virginia as an eight-room hospital to our modern not-for-profit regional system, Mary Washington Healthcare has seen enormous growth and development in the past 100 years. Today, we are made up of two hospitals and 28 healthcare facilities and wellness services. Community leaders volunteer on our Board of Trustees in order to guide the continued growth and direction of our health care system.