Insurance Follow-Up Specialist en None

Schedule: M-F 8:00a-5:00p, on-site at the Main Street Houston Location

Key Functions

1. Manages the processing of commercial claims through account resolution
   1. Work with third party carriers to obtain eligibility and out-of-pocket expenses.
   2. Monitors claim status via telephone, internet, and/or fax.
   3. Review and interpret contractual terms and explanation of benefits.
   4. Identify and post contractual adjustments, third party payments, and out of pocket remittances.
   5. Set up, maintain, and edit payment arrangements on patient accounts, as necessary.
   6. Monitor and resolve delinquent accounts through the organization’s collections process.
   7. Processes credit balances and overpayments.
2. Maintain knowledge of information and functionality.
   1. Observes all HIPAA required practices including, but not limited to, maintaining HIPAA compliance and confidentiality for all patient and clinic information.
   2. Maintains knowledge of computer system functions as it pertains to Patient Accounts.
   3. Enters patient demographics, insurance information, charges, and adjustments to Outpatient accounts.
3. Assist with other Revenue Cycle projects and other duties as requested.
4. Accepts additional assignments willingly.
   1. Demonstrates an ability to respond to changing workloads.
   2. Assists Utilization Review with initial authorizations and concurrent reviews.

Education Required: High school diploma or equivalent required. Associate’s degree in business or related field preferred

License/Certification: Medical Billing Certificate, CRCR, CRCS, CHAA Preferred

Experience Required: Two years of Revenue Cycle and hospital experience. Knowledge of Microsoft Office, including Word, Excel, and Outlook