Account Follow-up Specialist II

at  Legacy Health

MAINTAINS A WORKING KNOWLEDGE PERTAINING TO INSURANCE ISSUES WHICH INCLUDES BUT IS NOT LIMITED TO MOTOR VEHICLES, WORKER’S COMPENSATION, MEDICARE, OHP/WASHINGTON WELFARE/MEDICAID BLUE CROSS AND COMMERCIAL PAYORS.

Qualifications:

EDUCATION:

High school graduate or equivalent.

EXPERIENCE:

Two years of directly applicable healthcare business office experience (billing/credit/collection) required.

SKILLS:

Demonstrated negotiating, problem-solving and decision-making skills.
Demonstrated understanding of complex collection issues inherent in high dollar/specialty accounts.
Demonstrated knowledge of multi-payor systems.
Demonstrated knowledge of billing/collection rules and regulations.
Knowledge of online systems for eligibility and status review of claims.
Net Typing of 40 wpm and PC based computer skills.
10 key proficiency.
Knowledge of medical terminology.
Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.
Demonstrated effective interpersonal skills which promote cooperation and teamwork.
Ability to withstand varying job pressures and organize/prioritize related job tasks.
Excellent public relations

Acts as key trainer to new departmental employees on team policies/procedures.
Demonstrates understanding of Rebill procedure by ordering appropriate dollar amounts, using proper forms and documenting actions accurately.
Accurately determines when medical records are needed on an account, completes the medical record requests, and forwards to the proper party. Sets appropriate A/R flag and documents all related activity in MS4 system.
Properly obtains Explanation of Benefit materials when necessary and clearly explains EOB information to interested parties.
Understands and follows Legacy procedures for writing off balances and adjustments. Properly exercises authority for write-offs.
Obtains Itemized Statements when requested and ensures receipt by requesting entity/person.
As patient account representative, answers telephone calls and written questions from customers pertaining to account status and pending action.
Transfers payments if determined appropriate after interviewing customers and reviewing records in question.
Determines whether misapplied payments were made and adjusts if appropriate.
Files refund requests after determining appropriateness, amount and recipient of refunds.
May be responsible for processing certain reports such as Month End, Flag, PARS, Expected Reimbursement, Carrier Code 0414, Carrier Code XX50, or HCFA electronic reports.
Tracks and reports total number of accounts received weekly.
May be assigned to work A/R Reduction reports within responsible area.