The representative follows up on outstanding hospital patient accounts for insurance payment, communicates with payors, and resolves claims.
- Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation within patient accounts providing steps taken to resolve outstanding insurance balance on account.
- Work an average of 30-40 patient accounts per workday for assigned payor(s)
- Manages an average of 30-40 patient accounts per day, focusing on denial and zero-pay reporting.
- Assigned Payor denials and Zero ($0) pay reports worked within 48 hours of receipt
- Communicate effectively with insurance companies for payment of outstanding insurance balances, understanding of next steps needed to reach resolution of outstanding insurance balance
- Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows
- Responsible for resolving patient accounts with outstanding insurance claims to a zero balance or advancing them to the patient responsibility financial class.
- Performs account follow-up on unpaid or partially paid insurance claims for hospital services.
- Contacts insurance payors through various methods, including telephone calls, Insurance payor web portals, E-faxing, email
- Investigates the cause of non-payment towards outstanding hospital claims and takes appropriate actions such as: Requesting insurance companies to process claims, requesting cash posting review for corrections, initiating coding reviews for account resolution, contacting patient for insurance information
- Completes adjustment requests for Team Lead approval if an adjustment to the outstanding balance
- Submits requests for claim rebilling when additional information is required, using either a shared spreadsheet or the EHR system. Utilizes MEDTEAM’s ticketing system to submit claim inquiry requests if additional information or review from the hospital is required.
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Medteam Ticketing System
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