A/R Specialist/Insurance Follow Up Representative

Description:

• Log on to various applications (billing system). Currently, the majority of billers broken down by payer, so there are additional systems to log into based on the assigned payer.
• They are also assigned various queues & filter them down based on certain criteria.
• Afterwards, they go into the accounts & review/research them. They'll do what's call a "transaction inquiry" where they are looking to see what edits/updates need to happen based on previous work OR the rejection code or denial reason (could also be no response from the payer).
• They are contacting the payer or going to the website. In the case of an abnormal rejected claim, they will notify manager or TL of the trend then work with managed care for a resolution & notate the account.
• Denial rejections get worked & the account is notated.

Additional Skills & Qualifications:

• Portal knowledge is helpful - Availity & Change Healthcare.
• Appeals background would be great
• Medicaid/Medicare & commercial insurance

Experience Level:

• Expert Level