Insurance Follow Up Representative

Overview
As an Insurance A/R Specialist, you'll collect payments for an assigned segment of the insurance accounts receivable and perform insurance follow up duties in accordance with established federal and state regulations. You'll also appeal claim denials as necessary and appropriate.

Responsibilities
* Researches and prepares insurance credits for refund approval
* Maintains an error rate in accordance with departmental policy
* Follows-up with insurance companies and ensures claims are paid/processed
* Makes changes to demographic information as necessary in order to produce a clean claim
* Reviews and appeals unpaid and denied claims, includes analysis of coding that assures proper billing
* Services each account in priority of importance and independently billing accounts with understanding of all applicable insurance and/or CMS regulations
* Resubmits insurance claims that have received no response or are not on file, in a timely manner according to each insurance's contracted filing limits

Metrics
* Dollars collected and daily counts - minimum standards is 45 encounters per day
* Tier 3 would need to be at 56 encounters per day
* 90% or higher in accuracy and attendance

Qualifications
* Knowledgeable with commercial and AZ government payers
* Active knowledge of CMS guidelines, contracted insurance guidelines, and coding policies
* 2+ years of strong Insurance A/R experience (not patient), with a focus on reconsiderations and denials

Schedule
* Training will be Monday to Friday 8:00am to 5:00pm for the first two weeks
* Monday to Friday 6:00am to 5:00pm, any 8 hour shift with a start time between 6:00am to 8:00am

Pay
* $18 to $25 an hour

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.