Pride Health is hiring an Insurance Follow-Up Representative for one of its clients in Wisconsin.
This is a 3-month contract with a possible extension with competitive pay and benefits.
Job Title: Insurance Follow-Up Representative
Pay range:$20 - $25 per hour (Depending upon relevant experience)
Location: Menomonee Falls, Wisconsin (53051)
Duration: 3 months (possibility of extension)
Shift: M-F flexible
Job Summary
Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.
Job Duties
Answers patient calls and research and responds to patient concerns within 24 working hours.
Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule, and surgical group methodologies.
Applies knowledge for accurate resolution of claims within contract terms.
Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Manual), HMO/PPO agreements, and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals.
Serves as backup to the person primarily on taking incoming calls.
Monitors queue light to ensure minimal wait times for patients in the call queue.
Identifies denial trends and reports issues to the Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons.
Participates in cross-training efforts for specific systems based on goals set by the PFS department.
Addresses account qualifying to a workstation within one week utilizing system-specific follow-up procedures.
Coordinates efforts with ancillary departments as needed promptly for effective resolution.
Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients.
Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions.
Updates and verifies payor-specific account information.
Education, Experience, and Skills:
A High School diploma or equivalent is required.
Five years of experience in billing, customer service, or collections in a healthcare environment is required.
Three to four years of leadership experience is required.
Previous supervisory experience is preferred.
Demonstrated skills in planning, directing organizing, and implementing projects.
Recent experience in healthcare reimbursement and knowledge of medical coding and billing.
Problem-solving and well-developed analytical skills are required.
Effective written and verbal communication skills.
Well-developed personnel management and leadership experience.
Experienced user of Excel and Word
"Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors. "