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Role Description

The primary responsibility of this position is to follow-up with insurance payers on outstanding claims, break down obstacles to payment, and accelerate cash collections.

• Responsible for follow-up and collecting on accounts in assigned inventory.
• Utilizes experience and follow-up strategies and tools to resolve claims and obtain payment.
• Escalates unpaid claims to payer claims supervisor as appropriate when regular follow-up efforts are not successful.
• Documents client’s host system utilizing the 5 W’s framework and related policies/procedures to ensure accurate and complete documentation.
• Copies account notes into Amplify’s workflow tool.
• Assigns appropriate status codes (e.g. root cause, action, etc.) in Amplify’s workflow tool so trends can be identified and addressed.
• Writes first and second level appeals of all denials in effort to overturn and secure payment.
• Escalates payer denial and other trends to Management for further assistance.
• May also work assigned underpayments as assigned by Management.
• Maintains client and/or position specific daily productivity and quality expectations.
• Researches and analyzes any correspondence received related to assigned accounts.

Qualifications

• Must adapt and demonstrate the ability to work independently from home in a fast-paced, changing and goal-oriented environment.
• Direct account follow-up and/or billing experience.
• Medical Terminology, ICD-10, CPT and DRG knowledge preferred.
• Knowledge of third-party billing.
• Intermediate experience in Excel preferred.
• Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
• Demonstrates understanding of the entire revenue cycle.
• Must be detail oriented, organized, and possess the ability to apply critical thinking skills.
• Assists with problem solving, inquiries, and customer interaction to ensure positive results.

Requirements

• High school diploma or equivalent; additional training in hospital insurance collections is a plus.
• 3-5 years of collections experience in a Hospital Business Office.

Working Conditions and Physical Requirements

• Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment.
• The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools.
• Primarily requires sitting at a desk for extended periods. Proper lighting and ergonomics should be maintained to reduce eye strain.
• Reliable high-speed internet connection is required for all remote/hybrid positions.
• Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities.
• A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations.

Travel Requirements

• None