The A/R Follow-up Representative – Non-Government Claims is responsible for the follow-up on all private pay and commercial insurance claims. This role entails the resolution of unpaid accounts in a timely and efficient manner for multiple geographical areas.
- Review, modify as necessary, and re-bill rejected/denied claims in “queue” by assigning appropriate insurance carrier, utilizing the billing address and/or payor prefix.
- Process “queues” within appropriate timeframes, (e.g. claims status checks, appeals of denied claims).
- Recode private pay, commercial insurance and HMO claims, assigning proper condition codes/ICD-9 codes/procedure codes into the Accounts Receivable Billing System and re-file claims as necessary.
- Update appropriate modifiers, based on origin and destination of trip and change insurance claims as necessary.
- Create narrative in the Accounts Receivable Billing System to document status of trip for use in claim appeal process.
- Ensure that charges are billable to a particular commercial payor, based on the payor’s criteria, as needed; Resolve payment issues with carriers.
- Resolve payment issues with carriers, (e.g. denials, partial payments, etc).
- Appeal claims as necessary.
- High School Diploma or GED required; Associates Degree or certificate of completion from a coding and billing school preferred
- Must pass new-hire and department-specific testing.
- Minimum one (1) year previous medical billing experience required, ambulance billing experience preferred.
- Knowledge of Terminology on a PCR, Hospital Face Sheet, and/or a CAD Sheet.
- Proficient in the Accounts Receivable Billing System and Internet, (e.g. Internet mapping programs, eligibility websites, address search engines).
- Understanding of Government coverage guidelines, filing limits and necessary prior authorizations; knowledge of Payor-specific requirements for one or more geographical areas and/or financial classes.
- Able to make Distinctions between ALS/BLS/SCT/Gurney/Wheelchair/CCT levels of service.
- Knowledge of ICD-9 coding/condition codes and procedure codes
Integra Connect, LLC provides a comprehensive benefits plan.
- Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
- 401k with employer match
- Paid Time Off
- Paid Holidays and Floating Holiday
Equal Opportunity Employer
|Job Category||Revenue Management|