In this role, you will collaborate closely with a hospital's central business office to address outstanding insurance balances and review payer balances, contracts, and Explanation of Benefits (EOBs) to ensure appropriate account resolution. With your expertise and attention to detail, you will play a pivotal role in streamlining the insurance follow-up process, claim denials, ensuring efficient and effective account management, and maintaining positive working relationships with both the hospital and insurance providers.

Position Responsibilities:

• Initiates proactive measures that result in account resolution, which also may include direct and professional contact to the patient(s).

• Exhibits professionalism and exemplary customer service skills by managing phone interactions with efficiency, addressing inquiries thoroughly while maintaining a courteous demeanor.

• Responds timely and accurately to all incoming correspondence and inquiries from insurance companies, and other appropriate parties.

• Stay engaged with industry knowledge in accordance with federal, state, and payer mandated guidelines.

• Ensures meticulous record-keeping by documenting comprehensive activity that captures account details, actions taken, and relevant information for future reference for audit purposes.

• Adheres to established protocols and guidelines, diligently following up on accounts and leveraging systematic processes to drive consistent, compliant, and efficient account management.

• Confidently identify payer specific issues and trends to management division. In addition, further research may be required and assigned as determined.

 Job Requirements:

• Quality computer skills and a comprehensive command of essential Microsoft applications; Outlook, Word, Excel, and Teams.

• Review EOB’s to ensure that appropriate steps are taken in resolving accounts; Investigate, follow up with payers, and take appropriate action on insurance and legacy accounts assigned.

• Detail-oriented and able to research accounts to bring them to an appropriate account resolution.

• Ensure proper claim submission and payment through review and correction of claim edits, errors, and denials.

• Work with integrated automation software to determine non-payment and take appropriate escalation steps required.

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited information is provided.

Preferred Experience:

• High school diploma or general education degree (GED); or one to three years related experience and/or training.

• A medical background with 1+ years of experience in patient financial services and/or insurance follow-up is preferred.

• Experience with Epic preferred

• Holding a professional certification such as the CHFP, CRCR, CPC, or CPB is not a prerequisite; however, these credentials are highly valued for this role.