Account Follow-Up Representative II

The Account Follow-up Representative II is responsible for the review and resolution of outstanding insurance balances on hospital patient accounts.

The Account Follow-up Representative II is required to learn multiple hospital systems, conduct research analysis, utilize intermediate skills to work basic to complex outstanding insurance claims, work closely with third party payors to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims.

Primary Duties:


* Timely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient’s insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution


* Work an average of 40-50 accounts per workday for assigned payor(s)


* Assigned Payor denials and Zero ($0) pay reports worked within 24 hours of receipt


* Gather additional demographic, clinical information, medical records, authorizations, and insurance related information deemed necessary to pay outstanding medical claims and update the applicable systems with the patient’s information


* Ability to prioritize job responsibilities and manage time effectively for completion of assignments


* Analyze, communicate, and participate in resolving denial/variance trends and payor issues with other teams/departments within the organization


* Identifies and prepares less complex claims for reconsiderations and appeals


* Assists leadership in managing assigned A/R and ensure resolution of outstanding insurance balances at 90 days post discharge


* Works closely with third party payors and takes next steps to reach resolution of outstanding insurance balances. 


* Must have the ability to deliver education and training for new hires along with assisting less experienced representatives.


* Perform research on patient accounts with outstanding insurance balances and route patient accounts through appropriate workflows


* Review and recommend adjustments to accounts in accordance with payor, company, and client guidelines


* Participate and complete projects assigned by team lead or manager to fulfill clients’ contractual agreement of services


* Work in partnership with other teams/departments regarding resolution of project issues, concerns, and workflows


* Complete assigned LinkedIn learning path within the calendar year


* Attend role-based education courses within the calendar year


* Assists leadership with special projects and/or stretch assignments


* Other duties as assigned

Administrative Duties:


* Accurately input/submit worked time by the required departmental deadlines


* Maintain knowledge of insurance payors and collection regulations


* Maintain industry knowledge through self-study and by attending training classes


* Attend and particip...