Account Follow-up Representative

This role is a professional service position.

 
The Account Follow-up Representative is responsible for review and resolution of outstanding insurance balances for hospital patient accounts. The Account Follow-up Representative is required to learn multiple hospital systems, conduct research, and work basic & complex patient accounts with outstanding insurance claims in pursuit of resolving unpaid claims. The primary goal of an Account Follow-up Representative is to complete tasks related to timely resolution of unpaid insurance claims.

Primary Duties

· 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 within patient accounts providing steps taken to resolve outstanding insurance balance on account.

· Work an average of 30-40 patient accounts per workday for assigned payor(s)

· Manages an average of 30-40 patient accounts per day, focusing on denial and zero-pay reporting.

· Assigned Payor denials and Zero ($0) pay reports worked within 48 hours of receipt

· Communicate effectively with insurance companies for payment of outstanding insurance balances, understanding of next steps needed to reach resolution of outstanding insurance balance

· Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows

· Responsible for resolving patient accounts with outstanding insurance claims to a zero balance or advancing them to the patient responsibility financial class.

· Performs account follow-up on unpaid or partially paid insurance claims for hospital services.

· Contacts insurance payors through various methods, including telephone calls, Insurance payor web portals, E-faxing, email

· Investigates the cause of non-payment towards outstanding hospital claims and takes appropriate actions such as: Requesting insurance companies to process claims, requesting cash posting review for corrections, initiating coding reviews for account resolution, contacting patient for insurance information

· Completes adjustment requests for Team Lead approval if an adjustment to the outstanding balance 

· Submits requests for claim rebilling when additional information is required, using either a shared spreadsheet or the EHR system. Utilizes MEDTEAM’s ticketing system to submit claim inquiry requests if additional information or review from the hospital is required.

Minimum Qualifications:

• High School or equivalency diploma required
• 2 years’ experience in account follow-up role performing follow-up on hospitals’ inpatient and outpatient insurance claims   

Soft Skills:

• 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
• 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

The job role operates in a professional office or remote home office environment. The role utilizes standard office equipment such as computer, monitors and telephone. The role utilizes software to complete daily tasks, the following are a few examples of software utilized: the hospital's EHR, billing clearinghouses, MicroSoft products (Excel, Outlook email, Teams, Word), insurance payor portals, e-faxing solutions.

It is essential that the employees adhere to confidentiality requirements as outlined in the Employee Handbook and Harris' Security and Compliance Policies as this job role will encounter private and protected information.