Claims Escalation Specialist (Medical Insurance Follow Up)

at  Fast Pace Health

Posting Title: Claims Escalation Specialist (Medical Insurance Follow Up) Overview:
Fast Pace Health strives to provide a best in class patient experience in every interaction. We are seeking a highly-skilled, experienced Claims Escalation Specialist (Medical Insurance Follow Up) to join our growing team. Our ideal candidate will be deeply committed to nurturing our Fast Pace mission of teamwork, communication, empowerment and quality care in a friendly and encouraging environment.
Fast Pace Health aims to push for a new vision of healthcare in rural communities that will consist of an array of different services. We are changing the delivery of healthcare in these rural areas by integrating excellent patient care, education, accessibility, and community service, in a way that puts the patient’s needs first and improves the health status of our communities.
Why Choose Fast Pace Health?:
Fast Pace Health is a growing company! You will have the support and mentoring you need to become the best Claims Escalation Specialist (Medical Insurance Follow Up) you can be! We will help you grow your competencies, and can offer you a rewarding career path. We work as a dynamic team to surpass our business goals by ensuring our patients receive the best care possible in a positive environment.
We offer competitive compensation and benefits such as holiday pay, PTO, medical, dental, vision and Work-Life balance, to name a few.
As a Fast Pace Health employee you will have the opportunity to participate in community events and outreach programs. This includes, but is not limited to, seasonal parades, book drives, festivals, trunk or treating, fun runs, and more. We dress up for holidays and celebrate with pot lucks. At Fast Pace, our community is our family, and we are a family first community.
Responsibilities:
The Claims Escalation Specialist (Medical Insurance Follow Up) will perform the daily collections and management of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments. The Claims Escalation Specialist (Medical Insurance Follow Up) will provide effective customer service for all internal and external customers by using, excellent, in-depth knowledge as well as communicating effectively with team members and strong customer service.
This is a full-time, remote role with working hours Monday-Friday 7am-7pm CST (flexible start/stop times).

What You Will Do:

• Performs daily on collecting and managing of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments.
• Collaborates with Manager of Claims Escalation & Processing, and Director of Revenue services to report denial trends to ensure proper claim resolution.
• Collaborates with patients, vendors, and internal departments to resolve conflicts on accounts and resolve any outstanding claims for unapplied/unidentified invoices.
• Ensures accuracy in claims escalation (denials management) while adhering to all regulations.
• Participates with the team to implement and adhere to policies, procedures, and systems to ensure timely resolution of claims in current Practice Management system.
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals.
• Collaborates with Manager of Claims Escalation & Processing to create new processes and procedures as needed to improve overall claims escalation process.
• Performs a variety of administrative duties including, but not limited to: answering phones, faxing and filing
• Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training.
• The ability to maintain friendly, cordial relations with fellow coworkers.
• The ability to build and maintain confidence and credibility with fellow coworkers.
• The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
• The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
• Ability to comply with Company standards of operations.
• Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.
• The ability to promote and maintain a respectful culture of employee, employer and business confidentiality.
• Perform other duties as assigned by management.

Experience Requirements and Preferences::

• 1+ year of experience with Claims Escalation or Insurance Follow Up (Blue Cross Blue Shield/BCBS Commercial Payers experience preferred)

Education Requirements:: High School Diploma or Its Equivalent Compliance:
Fast Pace is committed to the principle of equal employment and creating an inclusive environment for the benefit of our employees, our patients, and our communities. We are an equal opportunity employer and welcome job applications from qualified individuals without regard to race, creed, color, ancestry, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, marital status, parental status, genetic information or any other legally protected characteristics or conduct.
Please refer to links below for information regarding your rights under certain federal laws:
https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf
https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf
Mississippi Residents Only:
In Mississippi, employers may require pre-employment drug/alcohol tests as a condition of employment. If Fast Pace engages in this practice, the law requires that Fast Pace notify applicants, in writing, upon application and prior to the collection of the specimen for drug and alcohol test, that they may be tested for “the presence of drugs [or alcohol] in their metabolites.” Miss. Code. Ann. § 71-7-3(5).

• Performs daily on collecting and managing of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments.
• Collaborates with Manager of Claims Escalation & Processing, and Director of Revenue services to report denial trends to ensure proper claim resolution.
• Collaborates with patients, vendors, and internal departments to resolve conflicts on accounts and resolve any outstanding claims for unapplied/unidentified invoices.
• Ensures accuracy in claims escalation (denials management) while adhering to all regulations.
• Participates with the team to implement and adhere to policies, procedures, and systems to ensure timely resolution of claims in current Practice Management system.
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals.
• Collaborates with Manager of Claims Escalation & Processing to create new processes and procedures as needed to improve overall claims escalation process.
• Performs a variety of administrative duties including, but not limited to: answering phones, faxing and filing
• Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training.
• The ability to maintain friendly, cordial relations with fellow coworkers.
• The ability to build and maintain confidence and credibility with fellow coworkers.
• The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
• The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
• Ability to comply with Company standards of operations.
• Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.
• The ability to promote and maintain a respectful culture of employee, employer and business confidentiality.
• Perform other duties as assigned by management