Follow-Up Specialist
$38,147–$38,147 year
On-siteSpringfield, Illinois, United States
Job Summary
Verify patient insurance eligibility and account status by accessing external provider websites and reviewing daily claim listings. Investigate incomplete or incorrect information on assigned accounts to resolve errors and ensure claim compliance. Follow up on unpaid items by contacting patients, guarantors, and third-party payors to secure prompt payment. Process claim denials, rejections, and underpayments by preparing appeal paperwork and initiating corrections to charges and contractual allowances. Research complex issues involving medical insurance claims and coordinate resolutions with internal departments, social service agencies, and collection agencies. Document system edits and electronic files to track claim status and report problematic trends to management.
Required Qualifications
- Education equivalent to graduation from high school or GED
- Two or more years as an Account Follow-Up Specialist
- Comparable years of medical insurance and/or health care billing experience
- Technical knowledge to independently process claims of any denomination, type, and complexity
- Thorough knowledge of the electronic billing system
- Thorough knowledge of medical terminology
- Thorough knowledge of medical procedural (CPT) and diagnosis (ICD-9 CM) coding
- Thorough knowledge of DRGs and hospital billing claim form UB-04
- Thorough knowledge of contract management systems
- Thorough knowledge of Blue Cross and Tricare guidelines
- Basic working knowledge of personal computers and their associate user software
- Ability to work within the guidelines of defined managed care contract policy provisions and company procedures
- Demonstrated ability to work successfully with internal customers and external contacts
- Highly-developed prioritization and organization skills
- Critical thinking and problem solving ability
- Excellent communication skills, including telephone etiquette
- Keyboarding and basic math skills
Desired Qualifications
- Experience with Microsoft Office products Word and Excel
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