Job Description

Insurance Follow-Up Representative

Pride Health is hiring an Insurance Follow-Up Representative for one of its clients in Wisconsin.

This is a 3-month contract with the possibility of an extension with competitive pay and benefits.

Location – Milwaukee, Wisconsin (53226)

Length of assignment – 3 months (Possibility of an extension)

Pay range - $20 - $25 per hour.

Shift – Monday-Friday 8-hour shifts, Shift start times between 7:00 am -9:00 am.

Job Summary

Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.

Job Duties

• Answers patient calls researches and responds to patient concerns within 24 working hours.
• Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule, and surgical group methodologies.
• Applies knowledge for accurate resolution of claims within contract terms.
• Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Manual), HMO/PPO agreements, and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals.
• Serves as backup to a person primarily on taking incoming calls. Monitors queue light to ensure minimal wait times for patients in the call queue.
• Identifies denial trends and reports issues to the Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons
• Participates in cross-training efforts for specific systems based on goals set by the PFS department.
• Addresses account qualifying to a workstation within one week utilizing system-specific follow-up procedures.
• Coordinates efforts with ancillary departments as needed promptly for effective resolution.
• Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients.
• Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions.
• Updates and verifies payor-specific account information.

Requirements

• High School Diploma or GED Required.
• 2 years of business office experience in billing, customer service, or collections in a healthcare environment – Required
• Insurance follow-up experience preferred, attention to detail,
• Insurance website experience preferred,
• Epic experience preferred.

Benefits

Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Opportunity Employer

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

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