Optim Health System is seeking a full time Insurance Follow-up / Denial Representative I -

Job Requirements :

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :

• Works with Insurance payers to ensure proper billing takes place on all assigned patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts.
• Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s).

Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts. Assists Customer Service with Patient concerns / questions to ensure prompt and accurate resolution is achieved.

Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc.

Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account for proper billing protocols.

Initiates next billing, assign appropriate follow-up and / or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate.

Sends initial or secondary bills to Insurance payers.

Documents billing, follow-up and / or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor / Manager if necessary.

Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and / or Manager.

• Remains in consistent daily communication with team members, including new process education, regarding all aspects of assigned projects.
• Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Supervisor and / or Manager.

Assist in training new staff, performs audits of work performed, and communicates progress to appropriate Supervisor. Provides continuing education of all team members on process and A / R requirements.

Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account

Optim Offers :

• Competitive Pay
• Company Benefits
• Vacation, Personal Time Off, and Sick Leave
• Holiday Pay
• 401K Plan

Last updated : 2024-05-17