The Account Follow-up Representative is responsible for review and resolution of outstanding insurance balances on hospital patient accounts. The Account Follow-up Representative will be required to have flexibility in learning and comprehending complex hospital systems and keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Account Follow-up Representative will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client, and federal guidelines. The position requires professional Customer interaction and adherence to MEDHOST best practice methodologies.
• Follow-up on MEDHOST customer 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 day on assigned payor(s)
• Work assigned payor(s) zero pay report(s) 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
• Work outstanding accounts to resolution
• Basic understanding of Institutional (UB04) and Professional (1500) claim forms
• Perform duties and responsibilities in a positive manner that upholds MEDHOST policies and procedures
• Responsible for general office duties including but not limited to, filing, scanning, printing, and data entry
• Working knowledge of hospital information systems (MEDHOST experience preferred)
• Demonstrates the ability to learn new systems quickly and develop proficient operating skills within a reasonably short timeframe
• Understand both oral and written directives
• Ability to prioritize job responsibilities and manage time effectively for completion of assignments
• Accurately perform tasks with a high level of attention to detail
• Proficiency with telephone systems for outbound/inbound calls
• Perform account research and route accounts through appropriate workflows
• Completes timely follow-up on assigned accounts and documents findings in detail
• Review and recommend adjustments to accounts in accordance with payor and MEDHOST guidelines
• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOB) and Remittance Advices
• Understanding of Medicare, Medicaid, Commercial and other Government insurance payors
• Use critical thinking skills and payor knowledge to recommend system edits/updates to reduce denials and result in prompt and accurate payment
• Effectively answer emails, calls, TEAMS messages, and correspondence from patients, agencies, and facilities.
• Participate and complete projects assigned by team lead or manager to improve ongoing operations within the department
• Works in partnership with other departments regarding resolution of issues or concerns
• Complete assigned LinkedIn learning path within the calendar year
• Attend 6 role based education courses within the calendar year
• Assist with other assignments as needed
• Assist other members of the team as needed
• Other duties as assigned
Administrative Duties:
• Accurately input/submit worked time by the required departmental deadlines Maintain department documentation
• Maintain documentation regarding Customer interaction
• Provide training and training documentation in areas of expertise necessary to assist team members and Customers Maintain in-depth knowledge of the MEDHOST core products
• Maintain in-depth knowledge of insurance payers and collection regulations
• Maintain MEDHOST software applications utilized & industry knowledge through self-study and by attending training classes Attend and participate in team and departmental meetings
• Responds to email, TEAMS, and phone communications in a timely manner
• Ensure that all HIPAA Privacy and Security requirements and responsibilities are adhered to constantly Books travel in adherence to the company travel policy
• All other duties as assigned
