Insurance Follow-up Denial Specialist I

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September 9

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Optim Health System

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Wellness • B2C

Optim Health System is a regional health system operating hospitals, ambulatory surgery centers, and clinics that specialize in orthopedic care, interventional pain management, neurosurgery, and primary care. The system emphasizes patient-focused, high-quality, and compassionate care, offering Centers of Excellence for joints, spine, and other musculoskeletal services, as well as imaging, rehabilitation, and surgical services across community hospitals and outpatient facilities.

1001 - 5000 employees

Founded 1976

🧘 Wellness

👥 B2C

📋 Description

• Works with Insurance payers to ensure proper billing takes place on all assigned patient accounts. • Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s). • Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts. • Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc. • Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account for proper billing protocols. • Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. • Sends initial or secondary bills to Insurance payers. • Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary. • Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager. • Remains in consistent daily communication with team members, including new process education, regarding all aspects of assigned projects. • Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Supervisor and/or Manager. • Assist in training new staff, performs audits of work performed, and communicates progress to appropriate Supervisor.

🎯 Requirements

• One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management • High school diploma or GED • Able to work with advanced billing procedures. • Able to prioritize and multitask based on volume of work within specific deadlines • Knowledge of the Revenue Cycle and the links between departments: Charge Capture, Patient Access, HIM, Coding, and Patient Financial Services. • Working knowledge involving coverage, payment, compliance, and basic billing rules for Government and Managed Care payers. • Uses discretion when discussing personnel/patient related issues that are confidential in nature. • Ability to give and follow written and verbal directions. • Working knowledge of personal computer applications and proficient in word, excel and power point applications. Self-motivator, quick thinker, communicates professionally and effectively in English, both verbally and in writing. • Ability to work with all departments and all levels of management.