Job Description

Job Description

Job Description

Job Title: SBO Insurance Follow-up Representative

Division: MedSrv SBO

Reports to: Department Manager

FLSA Status: Non-Exempt

Revised Date: September 2022

SUMMARY: Responsible for working correspondence denials and insurance follow-up in a timely and accurate manner, in accordance with the work instructions provided for performing the following duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Properly works Work Queue, to determine corrections needed; re-bill claims within 3-5 days of practice corrections being made. Email Department Manager if unable to meet this timeframe.
• Properly works Work Queue by calling insurance payers when necessary to resolve patient disputes, or ensure questionable claims are processed correctly, rebill / appeal claims where / when necessary

· Use available resources to identify missing insurance payments as needed, and send them to the proper Work Queue.

· Properly works Work Queue from CS Team to review and determine course of action to resolve patient question, issue or dispute these may involve

Ø Tertiary Billing

Ø W9 Insurance Requests

Ø Wellness vs. Office visit review, send to coding work queue as necessary

Ø Take insurance calls and handle properly.

Ø WC / MVA – file claims, and take calls from insurance adjusters as necessary

Ø Patient refund request

Ø Merge accounts

Ø Police Custody

Ø Duplicate billed services

Ø Time spent with provider

Ø surgical procedures

Ø Verify if paid out of network correctly

Ø Change account to Self-Pay Rate

· Meet productivity standards as set by management.

· Send communication to the practice as needed for additional information or corrections to be made by the client with appropriate details of what is needed. Review, work or forward correction communication as needed when received from the practice.

· Responsible for forwarding information to manager and providing any updates to client contact information.

· Must know the client specialties, locations, and proper A/R information.

· Communicate claim trends resulting in denials or a decrease in payments. This information is to be sent to management with the payer, provider(s), number of claims and dollar amount affected.

· Keeps management informed of client problems in communication and correspondence.

· A new employee must be able to meet the established and agreed upon goals within 90 days of continuous employment.

· Must have the ability to get along with others in a close office setting.

· Must work efficiently at home meeting requirements.

· Must have the ability to concentrate for extended periods of time.

· Must be willing to function and cooperate as member of a team.

QUALIFICATIONS :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE :

High school diploma or equivalent; one-year related experience and/or training; or equivalent combination of education and experience required for entry level account representative. One year of previous related experience required for advanced level account representative. Good computer and keyboarding skills required. Must have knowledge of office software and medical billing software. You must be able to read, interpret, and/or follow up on an EOB denial as well as understand medical terminology.

LANGUAGE SKILLS :

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

MATHEMATICAL SKILLS :

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to interpret graphs.

REASONING ABILITY :

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand or walk. employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision, and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

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