Payment Review Specialist

The Follow-Up Representative is responsible for pursuing collection of all receivables from payers.

Responsibilities:

• Provides continual follow up on outstanding accounts through contacts and inquiries to payers to facilitate prompt resolution or payment based on the Follow-Up Department guidelines.
• Prepares and posts any necessary adjustments and claim changes on accounts though the system based on the follow up to expedite the collection process and to ensure the accuracy of the account daily.
• Confers with payers to determine the reason for unpaid balances and to negotiate payment commitments.
• Reviews assigned accounts, processes the debit and credit adjustments, rebills the account to payers and systematically moves monies back to the insurance or patient bucket and appropriate next action.
• Analyzes and calculates the payment and contractual amounts on remittances received from payers, and includes denied claims to ensure that patients are billed appropriately.
• Requests refunds or retraction as appropriate.
• Responsible for pursuing collection of all receivables from specialty payers (Workers' Compensation, auto/liability, foundations, and any other specialty payer).

Qualifications/Requirements:

• One year of experience in hospital billing required.
• Follow up or collections experience preferred, EPIC experience preferred.
• Demonstrated knowledge of collections management.
• Understanding of reimbursement methodologies, terms and payer billing requirements.
• Patient accounts and payment posting experience.
• Strong with identifying underpayments/overpayments.

Schedule/Shift: 8:30am-5pm