Healthcare Insurance Follow-Up Specialist
Company: The CSI Companies
Posted on: May 19, 2019
CSI Professional is actively seeking a Healthcare Insurance
Follow-Up Specialist?for a Contract position with our client
located in the Raleigh, NC?area. This is an exciting opportunity to
join our client?s,?a national medical group comprising providers of
neonatal, anesthesia, maternal-fetal and pediatric physician
sub-specialty services, team!? Schedule: Monday - Friday (normal
business hours) Pay: Based on experience ***Prior Medical
Collections experience?in a production-driven environment is
fundamental for success in this role.*** Overview: The Healthcare
Insurance Follow-Up Specialist?is responsible for effective and
efficient accounts receivable management of assigned payors. The
collections efforts on outstanding accounts includes: telephone
contact with payers as well as patients, working high volume
collection reports and correspondence, auditing accounts, appealing
denied claims as necessary, updating accounts as needed,
identifying carrier related denial trends and consistently meeting
departmental productivity standards.? The incumbent performs
required tasks on internal software as well as the Master Database,
electronic claims vendors? software and various applications as
well as using the internet to access payor websites. Extensive high
volume collections experience with HMO?s, PPO?s, Workers Comp,
Medicare and Medicaid. The successful individual must also be able
to communicate and collaborate effectively with other internal as
well as external resources in order to achieve desired results and
resolve issues. Qualifications?
- 3+ years collections exp in a high volume, healthcare / managed
care, production-driven environment
- Exp. w/ Denials/Appeals/Rejections/Aging
- Exp. with Payer websites
- Exp. w/ Managed Care Collection's
- Exp w/ Medicare/VA
- Associate's degree (A. A.) or equivalent from two-year college
or technical school; or three to five years related experience
and/or training; or equivalent combination of education and
- Understanding of medical terminology and protocols
- Ensures that claims are processed accurately through review and
audit functions to ensure timely payment. Responds to inquiries
regarding claims with under payment or non-payment. Responds to
inquiries, questions, and concerns from patients regarding the
status of claims in a clear, concise, and courteous manner.
Interfaces with external and internal customers to ensure optimal
efficiency of service.
- Monitors aging of claims to ensure timely follow-up and
- Coordinates, monitors, and manages the follow-up on unpaid
claims. Ensures follow-up and reimbursement appeals of unpaid and
inappropriately paid claims. Ensures appropriate documentation of
billing, follow-up, collection, and appeal efforts are recorded on
- Identifies, researches, and ensures timely processing of
billing errors and corrections as they relate to claims. Actively
participates in problem identification and resolution and
coordinates resolutions between appropriate parties. Reviews error
codes associated with claims to ensure correction, resubmission,
and subsequent payment. Analyzes common errors to support quality
assurance efforts. Ensures corrected claims are sent out and
monitored for payment.
- Maintains a working knowledge and understanding of CPT and
ICD-10 codes. Keeps current with health care practices and laws and
regulations related to claims collections through participation in
professional development activities.
- Prepares routine management reports, quality reports, and
special reports as directed by supervisor. Communicates collection
problems to supervisor and makes recommendations for changes.
- Performs assignments accurately and on time, as directed.
Assists other accounts receivable staff with workload and provides
back-up support in their absence. Maintains individual productivity
and performance standards.
- Participates in administrative staff meetings and attends other
meetings and seminars, as required. Assists in evaluation of
reports, decisions, and departmental results in relation to
established goals. Recommends new approaches, policies, and
procedures to influence continuous improvements in department?s
efficiency and services performed.
- Serves as a member of the Accounts Receivable Department Team.
Performs duties necessary to ensure the team?s projects/goals are
completed. Takes ownership of special projects, researches data and
follows through with detailed action plans.
- Consistently adheres to company, Departmental, Operational,
Office and HR policies and procedures. Reports to work, meetings
and professional obligations on time.
- Maintain strict confidentiality in accordance with HIPAA
regulations and Company policy, including divulging any patient
private health information (PHI) only on a need-to-know basis to
payers requiring the information for claims payment
- Performs other duties as assigned or requested. For additional
information, please apply!--
Keywords: The CSI Companies, Raleigh , Healthcare Insurance Follow-Up Specialist, Healthcare , Raleigh, North Carolina
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