JOB SUMMARY:
Due to growth, RSi is hiring a Medicaid Insurance Follow-up Representative. This position will be responsible for reviewing data to ensure the validity of insurance information for claims processing, answering inquiries involving individual accounts, and researching denials and account issues to ensure accuracy for payment. If you are enthusiastic, sharp, and committed, we would love for you to join our team. This is a remote position and individuals can live anywhere in the U.S.
Job Responsibilities:
• Responsible for reviewing and processing Medicaid automated scrub results output.
• Follow up with insurance carriers to determine reason for claims’ denials and work to resolve claims for payment.
• Process claims, payments, adjustments, refunds, denials, and unpaid insurance balances.
• Assess and correct demographics, insurance, and financial information.
• Provide accurate account maintenance and documentation.
• Serve as a liaison with insurance companies, third party payors, and administrative personnel.
• Analyze EOBs and account documentation to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.
• Review payor contracts and ensure accounts are resolved consistent with terms.
• Resolve insurance denials and file appeals with government and commercial carriers by:
o Accurately and efficiently processing the account including transaction recording and other functions.
o Staying up to date on contracts, regulations, procedures and other changes affecting the department.
o Reporting unusual accounts, account problems, and workflow issues promptly to supervisor.
o Demonstrating positive and professional communication skills.
• Perform other work duties as assigned.
Key Competencies:
• Results-Oriented
• Strong written and verbal communication skills
• Ability to handle and maintain confidential information
• Strong work ethic
Job Requirements:
• High School Diploma required
• 2-4 years of Insurance Follow-up experience in a hospital or physician’s office setting is preferred
• At least 1 year of general Epic navigational knowledge, with experience in billing within the Epic system is required
• Thorough understanding of CPT, DRG, HCPC, Procedure and Revenue codes, modifiers and their effect on reimbursement
• Experience with filing UB-04 and HCFA 1500 claim form required Physical Requirements:
• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.