Insurance Follow-Up Representative

Insurance Follow-Up Representative

At White Plains Hospital, you have an opportunity to work side-by-side with some of the most talented people in the world.

We have been widely recognized for our exceptional culture, world-class physicians, Magnet-designated nurses and passionate employees who make a real difference in our community. With tremendous growth opportunities, great benefits, and flexible work schedules, it is no wonder why we are consistently recognized as a Great Place to Work .

Position Summary

Responsible for initiating follow-up to third-party payers on outstanding accounts, reviewing insurance correspondence, and responding in a timely manner. Responsible for supplying third-party payers with appropriate billing information in order to adjudicate a claim. Responsible for assuring appropriate payment received in accordance with contract terms, reporting trends and collaborating with denials and variance teams to assure prompt and accurate payments. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate.

Essential Functions and Responsibilities Includes the Following :

1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors

2. Completes review of third-party outstanding balances and takes appropriate steps to resolve and reconcile outstanding balances

3. Processes patient and insurance refunds

4. Reviews open accounts for reconciliation and next steps to resolve open balances

5. Review cases with provider representative liaison to assure escalation and processing of outstanding balances

6. Contact payors and patients as needed to resolve open balances and account issues

7. Responsible for reviewing assigned work queues and ensuring all accounts are worked timely, especially high dollar and aged accounts

8. Reviews correspondence for appropriate action to resolve accounts

9. Assure clear and concise notes within the EMR for all transactions

10. Completes associated actions within the EMR such as insurance updates, adjustments and allowances as needed

11. Escalates issues to management and provider representatives regarding incorrect payer processing, contract issues and / or trends

12. Communicate with third-party representatives relaying issues and discussing payment expectations

13. Take appropriate actions to resolve issues in a way that results in payment and / or complete closure of insurance balance

14. Assure payor plan types and policy numbers are updated accurately within the EMR

15. Collaborates with teammates and vendors as needed to reconcile and resolve outstanding accounts

16. Review of claims to assure payers process claims timely and according to contract provisions

17. Responsible for timely completion of projects and tasks as assigned by management and feedback on outcomes

18. Responsible for ensuring productivity measures are met daily

19. Performs all other related duties as assigned

Education & Experience Requirements

High School Graduate or GED required

2–5 years previous patient accounting and insurance follow-up experience (hospital), preferred

Knowledge of medical terminology required

Familiarity with electronic medical record system, EPIC preferred

Proficiency with Microsoft Office / Excel to include PIVOTS and vlookup, intermediate level required

Must be detail-oriented, able to solve problems, multitask and perform various duties on demand

Certified Patient Financial Services Specialist (CPFSS) certificate required

Effective 12 / 1 / 2022, the HBI (Healthcare Business Insights) one-time certification course is required and must be completed during the onboarding period and prior to the start date.

Core Competencies

Teamwork, communication skills, problem-solving, adaptability

Must be able to speak, write, understand and communicate the English language

Effectively communicate with internal and external customers

Retains composure under stress

Integrity to handle the confidential aspects of work

Physical / Mental Demands / Requirements & Work Environment

May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) database and may be accessed through the hospital’s Intranet site (Employee Tools / SDS Access). A copy of the SDS database can also be found at the hospital switchboard, saved on a disc. (Standard for all Job Descriptions)

Must be able to remain in a stationary position at least 50% of the time

The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

Constantly operate a computer and other office productivity machinery, such as calculators, copy machines. and computer printers.

The person in this position will need to communicate with insurance plans and patients that may have questions. They must be able to accurately exchange information in these situations.

Primary Population Served

Check appropriate box(s) below :

Neonatal (birth – 28 days) Patients with exceptional communication

Salary Range (based on Full Time) : $53,187.74- 80,782.07

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