Address
Form of workOverview:
In the complex web of health care insurance and claims, you are a calm, organized problem-solver. With your advanced knowledge of the multi-payor system, you resolve delinquent payment issues. Your ability to communicate clearly, collaborate with others and maintain respect for all parties involved reflects the Legacy mission.
The Account Follow-up Specialist 2 investigates and evaluates patient account information, medical records and bills, billing and reimbursement regulations; analyzes each account and, using independent judgment, decides how to best proceed with follow-up to optimize reimbursement; removes barriers to processing claims; negotiates financial arrangements and individual contracts with third-party payors; rebills, transfers payments, requests refunds or adjusts misapplied payments as necessary; and understands and follows Legacy procedures for writing off balances and adjustments.
This is primarily a remote position – incumbents, who reside in Oregon or Washington only, may work at home, on the road or in a satellite location for all or part of their workweek. There may be occasional situations that require work to be performed on-site at an assigned Legacy Health location (central business office at NW 31st in Portland).
All new hires are required to come to a designated Legacy Health office location in Portland, Oregon prior to their start date for a new hire health assessment and to complete new hire paperwork.
Note that our employee health plan coverage is for providers based in the Legacy Health geographic region. To find providers in our network click here. Urgent and emergent coverage is available outside Legacy Health’s geographic region and telehealth is available within Oregon and Washington.
The ideal candidate will have Professional Medicare HCFA / 1500 follow-up experience, and will be well versed in Noridian CMS (or equivalent) portal re-openings, corrected claims and the DDE.
Responsibilities:Communicates with third party payors regarding current account status. Works towards quick resolution and payment of claims. Effectively applies knowledge of regulations and practices used in all types of reimbursement specialties such as Government, Commercial, Medicare, Medicaid, Workers Comp, Motor Vehicle Accident or Organ Transplant.
Calls third party payors to bring claims to payment as soon as possible, taking assertive action steps to remove barriers to payment and expedite “pended” claims.
Daily/Weekly account followup required for high dollar and specialty accounts.
Follows up on Interim claims (complex multiple claims per account for detailed transactions and high dollar responsibility).
Investigates when claims are suspended, denied, or not expedited.
Negotiates financial arrangements and individual contracts
May discount payment based on insurance interviews.
In account notes, accurately documents action taken and status of claim.
Effectively uses appropriate databases to obtain information needed to process claims.
Accesses and uses multi-payor on-line system.
Understands and uses USSP system for accurate claims payment dates and amount of payment and patient balance for all Regence Blue Cross products.
Obtains benefits, eligibility, PCP information, and authorization information when necessary to resolve payment issues.
Understands and uses FirstHealth Online system to determine OHP/Medicaid eligibility and to interpret when OHP is primary or secondary payor.
Understands and uses ACTS system appropriately in regard to datamailers and rebills.
Understands and uses E-CHART and Cerner Millennium systems to obtain telephone numbers, hospital, accident information and scanned insurance cards.
May use FSS system for Medicare-eligibility and payor issues.
Understands and uses Internet-based payor systems to obtain eligibility, authorization, and claim status information.
Guarantees that every initiative is taken on the LHS side to ensure prompt reimbursement of all accounts.
Monitors fast tracks and analyzes Carrier Trend payor delays; identifies payor problems that are impacting LH accts; applies understanding of information to reimbursement effort through problem solving and communication.
Contacts patients’ families, sometimes in sensitive situations, to resolve payment issues.
Works closely with social workers, medical records employees, case workers, attorneys, police agencies, provider representatives, CEOs, Insurance managers to ensure reimbursement.
Works closely with floor nurses to get newborn babies signed up for insurance coverage.
May be required to obtain insurance verification after the fact.
Obtains retro-authorizations for claims requiring additional information including Medical Records and appeal letters.
Writes appeal letters when clinical information not required.
Refers “irresolvable” accounts to Vice President, Director, and/or Manager for ASI litigation or legal consideration.
Performs other tasks related to overall billing/followup process as needed.
Acts as key trainer to new departmental employees on team policies/procedures.
Demonstrates understanding of Rebill procedure by ordering appropriate dollar amounts, using proper forms and documenting actions accurately.
Accurately determines when medical records are needed on an account, completes the medical record requests, and forwards to the proper party. Sets appropriate A/R flag and documents all related activity in MS4 system.
Properly obtains Explanation of Benefit materials when necessary and clearly explains EOB information to interested parties.
Understands and follows Legacy procedures for writing off balances and adjustments. Properly exercises authority for write-offs.
Obtains Itemized Statements when requested and ensures receipt by requesting entity/person.
As patient account representative, answers telephone calls and written questions from customers pertaining to account status and pending action.
Transfers payments if determined appropriate after interviewing customers and reviewing records in question.
Determines whether misapplied payments were made and adjusts if appropriate.
Files refund requests after determining appropriateness, amount and recipient of refunds.
May be responsible for processing certain reports such as Month End, Flag, PARS, Expected Reimbursement, Carrier Code 0414, Carrier Code XX50, or HCFA electronic reports.
Tracks and reports total number of accounts received weekly.
May be assigned to work A/R Reduction reports within responsible area.
Maintains a working knowledge pertaining to Insurance Issues which includes but is not limited to Motor Vehicles, Worker’s Compensation, Medicare, OHP/Washington Welfare/Medicaid Blue Cross and Commercial payors.
Qualifications:
Education:
High school graduate or equivalent.
Experience:
Two years of directly applicable healthcare business office experience (billing/credit/collection) required.
Skills:
Demonstrated negotiating, problem-solving and decision-making skills.
Demonstrated understanding of complex collection issues inherent in high dollar/specialty accounts.
Demonstrated knowledge of multi-payor systems.
Demonstrated knowledge of billing/collection rules and regulations.
Knowledge of online systems for eligibility and status review of claims.
Net Typing of 40 wpm and PC based computer skills.
10 key proficiency.
Knowledge of medical terminology.
Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.
Demonstrated effective interpersonal skills which promote cooperation and teamwork.
Ability to withstand varying job pressures and organize/prioritize related job tasks.
Excellent public relations
LEGACY'S VALUES IN ACTION:
Follows guidelines set forth in Legacy's Values in Action.
Equal Opportunity Employer/Vet/Disabled
