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DENIALS - Follow up on claims denials; contact appropriate party to research, coordinate and justify needed information; make appropriate corrections, obtain approvals and resubmit claims denials for payments; appeal denials through the payer required appeals process.
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Ensures that all accounts are monitored by business office associates/follow-up staff within set time frames, maintaining the integrity of the accounts receivable system and the connection between the clinical portion and the financial portion of the patient's bill and by providing accurate and timely reporting of collections, denials and accounts receivable statistics as needed by the Director of Operations and/or CEO.
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Previous experience working in a hospital or doctor's office as an insurance follow-up representative Preferred. New family members must have previous experience submitting claims, working denials and contacting insurance companies and payers to gather needed information for the appeals process.
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COLLECTIONS - Follow up on the collection of patient accounts, contact appropriate party (third party payers, other hospitals, patients) to obtain needed information; make appropriate corrections; obtain approvals and resubmit claim for payment.
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Monitors, follow-up, documents, and tracks payer responses/requests of completed clinical reviews, including approvals, appeals, and denials, and communicates these to the appropriate personnel [hospital staff, physician, DCM, Case Manager, Clinical Denial Management, and Centralized Business Office (CBO.
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Analyzes reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management. Analyzes reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management.
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Check for payment posting and receive list of unpaid claims from system; proactively follow-up on submitted claims to determine payment status through telephone or web contact in a timely manner; collect information from carriers about what specific documentation is needed to pay claim.
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Job DescriptionReceives and reviews past due accounts and follow-up documents. Personal computer, copier, phone system, fax machine. Visual acuity also necessary for filing and proofing documents.
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The Insurance Follow Up position is responsible for investigating unpaid claims for physician charges. Contacts Insurance companies to follow up on denied claims. This position reviews coding and medical necessity denials and processes corrections to re-file for payment.
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Conducts diligent follow-up on missing or incomplete pre-authorizations with third-party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as needed Submits notice of admissions when requested by facility.
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To ensure timely follow up on current and delinquent accounts in accordance with the Policy and Procedure and the BOM Monthly Calendar. Where applicable, responds to collection and audit requests timely from AR support departments i.e. CBO, Managed Care CBO Team, Accounting, Denials Department, etc.
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Ability to work harmoniously with other personnel and develop/maintain good personnel relations and employee morale Ability to work independently, to follow instructions, and to accept constructive feedback.
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Ensures that the request for information from Billing, Follow-Up, Collection, Customer Service, Cashier's, Reconciliation, Administration, Practice Management, Outsource Vendors and other areas are carried out timely.
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We are looking for a Senior Patient Account Rep to join the team This position under general supervision, may participate in any or all aspects of the patient processing and accounts receivable functions of the organizations including billing, charge entry, collection, registrations, scheduling, follow-up, coding, payment posting and credit balance resolution.
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Job Summary: To perform advanced patient financial service functions such as billing, follow up, receiving and reviewing correspondence, reviewing third-party and patient billing, and review and resolution of billing questions, register and schedule patients, ensure proper data integrity of patient demographics and billing.
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