City/State: Fredericksburg, Virginia
Category: Patient Services
Position Hours: 40Apply
Position Shift: Day (United States of America)
Job Requisition Number: R-6261
Job Department: 1007030 MWHC-Pt Accts Billing & CS
Job Posted Date: Nov 23, 2021
Start the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:
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.
Working at Mary Washington Healthcare
Whether you are a new grad, experienced clinical professional or wanting to begin a career in healthcare, there is no better place than Mary Washington Healthcare. As a Great Place to Work-Certified™ company we treat our Associates like family – with respect, understanding, and communication.
Safety is our top priority
As a healthcare system, patient and Associate safety is our priority which is why all Associates will be required to take the following vaccines*:
- Annual flu vaccine
- COVID-19 vaccine