[Hiring] Insurance Follow-up Specialist @Omega Healthcare Solutions

Role Description

Under limited supervision the Insurance Follow-up Specialist reviews and manages the billing and collections for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in filing insurance claims, determining correct reimbursements/adjustment/write-offs, and denial management. They also analyze plans to determine which benefits are covered, submit secondary insurance claims, generate patient statements, and follow-up on those submissions.

Essential Job Functions

• Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
• Analyze claims (denial/non-denial) in practice management systems, internal system and direct toward resolution (Payment, Adjustment & self-pay).
• Technical billing and denial follow-up on all assigned payer claims.
• Call Payer (Insurance/third parties) to resolve claims (denial/non-denial) after review from PMS, internal system & process toward resolution (Payment, Adjustment & self-pay).
• Identify potential process improvements, trends, issues and escalate to Supervisor.
• Be part of initial and all ongoing training sessions to enhance knowledge of RCM processes.
• Resolve complex patient account issues requiring investigation of system timeline comments, payer reimbursements and account transactions.
• Identify trends/payer issues and escalate complex payer issues to the Supervisor, as necessary.
• Maintain a working knowledge of client policies and procedures. Follow the Workflow documentation like SOP’s Update tracker, Issue Log and Trend logs.
• Maintain quality standards as determined by management.
• Assist the Manager or Supervisor in working priority reports promptly, effectively, and efficiently.
• Maintain accurate records within a collections database.
• Be a mentor to new employees and assist in their training and development.
• Perform other duties as directed.
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

Qualifications

• Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance.
• Full understanding of hospital/physician billing.
• Industry knowledge of guideline requirements for Medicaid, Medicare, commercial payors and HIPAA.
• Minimum 2-3 years’ experience in Denials Management/Collections/AR Follow-up.
• Experience with standard office software products.
• High School diploma or equivalent.

Requirements

• Ability to prioritize and multi-task in a fast-paced, changing environment.
• Demonstrate ability to work in all work types and specialties.
• Demonstrate ability to self-motivate, set goals, and meet deadlines.
• Demonstrate leadership, mentoring, and interpersonal skills.
• Demonstrate excellent presentation, verbal, and written communication skills.
• Ability to develop and maintain relationships with operations business partners by building personal credibility and trust.
• Maintain courteous and professional working relationships with employees at all levels of the organization.
• Work in accordance with corporate and organizational security policies and procedures.
• Demonstrate excellent analytical, critical thinking and problem-solving skills.
• Manage the Individual KRA’s as per the provided metrics.
• Meet the productivity and quality targets of clients within the stipulated time.
• Ensure timely follow-up on pending claims and prepare and maintain individual status reports.
• Skill in operating a personal or company owned computer and utilizing a variety of software applications is essential.

Benefits

• Comprehensive benefits package that may include health, dental, and vision coverage.
• Voluntary insurance options.
• 401(k) plan with employer match.
• Professional development opportunities.
• Paid time off and holiday pay.
• Opportunity to participate in bonus programs, commissions, or other variable incentive plans.

Company Description

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines.