Insurance Follow-Up Representative

Healthcare Outcomes Performance Company•Jacksonville, FL

6d•Onsite

About The Position

Established in 2001, Southeast Orthopedic Specialists is a regional leader in musculoskeletal medicine. We are dedicated to growing with our patients. Our reach will continue to expand to meet the needs of all patients, present and future. It is our wish to make industry-leading five-star orthopedic care accessible to as many people as possible. As Southeast Orthopedic Specialists continues to grow, we are hiring Insurance Follow-Up Representatives for our Central Business Office located in Jacksonville, FL ! Please see below for the functions and requirements for this position: Insurance Follow Representatives are responsible for following patient accounts, through the insurance payors to ensure proper reimbursement to the practice. In this role Insurance Follow Up Reps will: Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor. Appeal claims that have been denied for no auth, medical necessity, etc. Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement. Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts. Communicating with payors through phone calls, emails, and payor portals. Process and take action on any written correspondence from insurance payors. Identify and trend reasons for claim denials. Resolve claim discrepancies reported by patients and other clinical departments.

Requirements

Must have a minimum of two years of medical claims processing experience.
Must be able to read and understand the Explanation of Benefits and denial reasons.
Advanced computer knowledge, including Windows-based programs such as Word and Excel.
Experience working with Blue Cross/Blue Shield, Commercial insurance companies, and Workman's Compensation carriers.

Responsibilities

Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor.
Appeal claims that have been denied for no auth, medical necessity, etc.
Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement.
Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts.
Communicating with payors through phone calls, emails, and payor portals.
Process and take action on any written correspondence from insurance payors.
Identify and trend reasons for claim denials.
Resolve claim discrepancies reported by patients and other clinical departments.