Insurance Follow-Up Representative
Lehigh Valley Health Network
full-time
Posted on:
Location Type: Remote
Location: Pennsylvania • United States
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About the role
- Works collaboratively with department leadership to review and manage open Accounts Receivable, accurately documenting follow-up activities resulting in the resolution of underpayments and denials.
- Conducts root cause analysis of denials and takes the action necessary to resolve the denial escalating accounts to management that need to be submitted to the provider representative for contracting action.
- Identifies denial and underpayment trends that require computer system modifications and recommends necessary to implement corrective action.
- Prepares reports for meetings with provider representative and senior leadership, as required.
- Demonstrates knowledge of insurance carrier reimbursement requirements to evaluate underpayments that are related to insurance carrier clinical and payment policies.
- Conducts a root cause analysis of denials, taking the appropriate corrective action as required, escalating denial trends to management, and routing denials to the appropriate area for resolution.
- Calculates and submits adjustment and refund requests utilizing the appropriate adjustment code, refund reason, and clearly documents the account history.
- Identifies the patient out of pocket expense related to non-covered services, co-pays, deductible, and co-insurance allocating the patient responsibility to the patient within the timely filing limit.
- Demonstrates knowledge of and compliance with established organizational and departmental policies, procedures, objectives and goals.
- Works collaboratively with management to establish issue logs and account examples for meetings with the insurance carrier provider rep.
- Responds and reviews all emails and correspondence within 24-48 hours, manages mail received from patients and insurance carriers for appropriate distribution.
Requirements
- High School Diploma/GED
- 2 years of professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field.
- Excellent follow-up and verification skills.
- Excellent verbal and written communication skills.
- Knowledge of insurance contracts, and regulations.
- Proficient with Microsoft Excel, Word, and PowerPoint applications.
- Strong analytical, mathematical and organizational skills.
- Successful Completion of DOE and Revenue Cycle Education Training within 3 months of hire.
Benefits
- Health insurance
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
accounts receivableroot cause analysisadjustment requestsrefund requestsinsurance reimbursementbillingcollectionsdata analysisfinancial reporting
Soft Skills
collaborationfollow-upverificationcommunicationanalytical skillsorganizational skills
Certifications
DOE and Revenue Cycle Education Training