Account Follow-Up Representative II

Summary

Harris Computer is a provider of mission-critical software solutions, including healthcare information technology systems. The Account Follow-Up Representative II reviews and resolves outstanding insurance balances on hospital patient accounts by researching claims, working with third-party payors, managing denials and appeals, and updating account systems. This remote role also supports training, quality management, administrative processes, and cross-functional issue resolution.

Responsibilities

• Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution
• Work an average of 40-50 accounts per workday for assigned payor(s)
• Assigned Payor denials and Zero ($0) pay reports worked within 24 hours of receipt
• Gather additional demographic, clinical information, medical records, authorizations, and insurance related information deemed necessary to pay outstanding medical claims and update the applicable systems with the patient’s information
• Ability to prioritize job responsibilities and manage time effectively for completion of assignments
• Analyze, communicate, and participate in resolving denial/variance trends and payor issues with other teams/departments within the organization
• Identifies and prepares less complex claims for reconsiderations and appeals
• Assists leadership in managing assigned A/R and ensure resolution of outstanding insurance balances at 90 days post discharge
• Works closely with third party payors and takes next steps to reach resolution of outstanding insurance balances
• Must have the ability to deliver education and training for new hires along with assisting less experienced representatives
• Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows
• Review and recommend adjustments to accounts in accordance with the payor, company, and client guidelines
• Participate in and complete projects assigned by team lead or manager to fulfill clients’ contractual agreement of services
• Work in partnership with other teams/departments regarding resolution of project issues, concerns, and workflows
• Maintain the effectiveness and implementation of the MEDHOST Quality Management System and meet applicable regulatory requirements as needed
• Responsible for QMS procedures listed in QMS Procedure Crosswalk found in QMS Manual as applicable
• Attend role-based education courses within the calendar year
• Assists leadership with special projects and/or stretch assignments
• Other duties as assigned
• Accurately input/submit worked time by the required departmental deadlines
• Maintain knowledge of insurance payors and collection regulations
• Maintain industry knowledge through self-study and by attending training classes
• Attend and participate in team and departmental meetings
• Effectively responds to emails, telephone calls, voicemails, Microsoft Teams messages, and correspondence from patients, agencies, and facilities in a timely manner
• Adherence to all HIPAA Privacy and Security requirements and responsibilities
• Perform duties and responsibilities in a positive manner that upholds company policies and procedures

Skills

• Knowledge of revenue cycle processes impacting insurance reimbursements
• Knowledge of insurance follow-up processes with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Proficiency with telephone systems for outbound/inbound calls
• Skilled in making accurate arithmetic computations
• Excellent communication, good judgment, tact, initiative, and resourcefulness
• Must be detail oriented, organized, and ability to multi-task
• Possess ability to concentrate for long periods of time
• Ability to work individually and/or as part of a team
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives
• Must be flexible with a “can do” attitude and the ability to remain professional under high pressure situations
• Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe
• Understand both oral and written directives
• High School or equivalent diploma required
• 3+ years' experience in related medical field
• Must be able to follow directions and to perform work according to department standards independently
• Must be emotionally mature and able to function effectively under high pressure situations
• Sufficient in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned
• Customer Service oriented

Qualifications

Must Haves

• Knowledge of revenue cycle processes impacting insurance reimbursements
• Knowledge of insurance follow-up processes with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Proficiency with telephone systems for outbound/inbound calls
• Skilled in making accurate arithmetic computations
• Excellent communication, good judgment, tact, initiative, and resourcefulness
• Must be detail oriented, organized, and ability to multi-task
• Possess ability to concentrate for long periods of time
• Ability to work individually and/or as part of a team
• Ability to demonstrate supportive relationships with peers, clients, partners, and corporate executives
• Must be flexible with a “can do” attitude and the ability to remain professional under high pressure situations
• Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe
• Understand both oral and written directives
• High School or equivalent diploma required
• 3+ years' experience in related medical field
• Must be able to follow directions and to perform work according to department standards independently
• Must be emotionally mature and able to function effectively under high pressure situations
• Sufficient in Microsoft Office applications (i.e., Word, Excel, PowerPoint, etc.) to complete work assigned
• Customer Service oriented

Benefits

• Remote role, eligible to anyone in the U.S.
• Plenty of opportunities to grow your career
• Comprehensive medical, dental, and vision benefits
• 3 weeks of vacation plus 5 personal days to recharge
• Employee stock ownership, RRSP program, 401k + matching
• A chance to give back through community involvement
• Flexible work arrangements to suit your lifestyle