SCOPE OF POSITION: The Follow-up Rep 2 position is responsible for the reimbursement of claims from various insurance companies and or government payers. The position will maintain proper follow-up on assigned accounts using department's collection guidelines, policies, procedures, government rules and regulations and managed care contracts.

RESPONSIBILITIES:

• Responsible to assign accounts and meet department’s productivity expectation.
• Monitors and/or follow-up accounts by using insurance company’s web-portal and/or make telephone calls to assure timely resolution and accurate reimbursement.
• Responsible for identifying follow up problems and issues
• Contacts the insurance companies to inquire about denial reasons to ensure proper resolution is applied.
• Monitors and/or follows-up on accounts with precise documentation and calculations.
• Utilizes the previous documentation comments in order to follow up in the appropriate manner.
• Utilizes aging reports to monitor each account and resolves barriers to assure timely and correct payment
• Reviews remittance codes from EOB's and RA's to ensure appropriate payment or to identify denials or non-payment
• Works the current hospital information systems queues/processes set up for their specific assignment/payers as directed by Leadership.
• Refers all payer issues/problems to Leadership in a timely manner with specific examples.
• Responsible for complete, accurate, and timely documentation of all follow-up pertaining to the resolution of the account within the current hospital information systems patient financial record
• Provides support to Managed Care Collector 1 as needed
• Performs other duties as assigned.

REQUIREMENTS:

• Minimum of 3 year’s experience as a Follow Up Rep 1.
• Must have expertise with all managed care contracts, action plan procedures, government intermediaries, and has knowledge of current regulatory requirements
• Ability to perform complex mathematical calculations to adjudicate accounts appropriately.
• Ability to analyze and adjudicate complicated contractual arrangements
• Proficient with Microsoft Excel, Word, and PowerPoint applications
• Must demonstrate excellent communication skills while dealing with confidential financial matters

THE ABOVE DESCRIPTION COVERS THE MOST SIGNIFICANT DUTIES PERFORMED BUT DOES NOT EXCLUDE OTHER OCCASIONAL WORK ASSIGNMENTS NOT MENTIONED, THE INCLUSION OF WHICH WOULD BE IN CONFORMITY WITH THE FACTOR DEGREES ASSIGNED TO THIS JOB.