Insurance Follow-up Rep - On-site

The Insurance Follow–up Representative’s responsibility is to reduce outstanding insurance due balances accurately and in a timely fashion to ensure a positive cash flow for the regional healthcare systems.

Regulatory Requirements:
• High school graduate or equivalent.
• Minimum of two years relevant experience, including knowledge of insurance billing and medical terminology.
• Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid.

What It’s Like Working At CMH: 

We are all about our team members growth and health. That why we prioritize work/life balance, community-based wellness initiatives and tuition reimbursement or student loan repayment for ALL of our team members. 

CMH offers a robust benefits package that includes: 

• Robust Paid Time Off (PTO) program 
• Medical plan with enhanced Tier 1 benefits provided within the CMH system. 
• Dental plan 
• Vision plan 
• Health Savings Account (HSA) 
• Basic Life insurance at no cost 
• Supplemental Life insurance 
• Long-term disability insurance 
• 401(k) or 403(b) retirement savings plans 
• Tuition IO partnership for student loan repayment assistance and tuition assistance 
• Family leave program for Parental Leaves 
• Comprehensive Wellness Program 

Duties and Responsibilities:
Demonstrates Competency in the Following Areas:
1. Contacts insurance companies to follow up on third party balances according to stratified processing environment principals.
2. Uses all available technology (i.e., phone, web-based systems, BLAST) to contact the appropriate agency/company to resolve account collection problems.
3. Documents all correspondence and conversations with insurance companies, governmental agencies, third party payers and patients on patient 's account.
4. Achieves a Quality Review score of 2.8 or better, 90% of the time.
5. Maintains WIP counts at or below goal.
6. Maintains productivity stats at or above baseline goals.
7. Maintains insurance company master according to departmental name and address standards.
8. Review and resolve credit balances according to departmental guidelines.
9. Reviews rejections from third party payors, acting appropriately on those when necessary.
10. Maintains a problem log to include all denials, claim issues, registration errors and other issues for monthly reporting to individual departments/practices.
11. Stays informed of changes in the insurance industry.
12. Consults with other CMMF departments to obtain, verify billing information.
13. Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage; ensures confidentiality of patient records.
14. Maintains a professional, working relationship with the insurance companies, government agencies and third-party payers.
15. Processes and completes all job responsibilities in compliance with regulatory requirements.
16. Works independently to resolve account problems.
17. Demonstrates the ability to be flexible, organized and function well in stressful situations.
18. Communicates clearly and accurately with the Supervisor.
19. Maintains a good working relationship within the department and with other departments of the Central Maine Medical Family.
20. Always accepts other assignments as needed.
21. Provides coverage for other team members when necessary, reorganizing workflow as necessary to accomplish this.

Language Skills:
• Able to effectively communicate in English, both verbally and in writing.
• Strong written and verbal skills.
• Additional languages preferred.
Skills:
• Basic computer knowledge.
• High level of interpersonal and communication skills.