GENERAL SUMMARY:

Performs account follow up and resolution of Insurance claims. Contact insurance payors on aged and or delayed claims for resolution. Ability to research accounts to complete appropriate follow up actions that result in an account payment and resolution. Monitor insurance claims for payment to resolve if not paid in a timely manner. Identify problem accounts and escalate as appropriate. Requires critical thinking skills, problem solving, decisive judgment, ability to work with minimal supervision and must possess excellent time management and organizational skills. Must be able to work in a stressful environment and take appropriate action.

ESSENTIAL DUTIES:

1. Performs account follow up and resolution of Insurance claims. Contact insurance payors via telephone on aged and or delayed claims for resolution.

2. Ability to research accounts to complete appropriate follow up actions that result in an account payment and resolution. Working knowledge of all facets of insurance claim filing, requirements and regulations.

3. Monitor insurance claims for payment to resolve if not paid in a timely manner.

4. Identify problem accounts and escalate as appropriate. Update patient accounts records to reflect action taken. Work with insurance and patients to secure timely payment on outstanding account balances.

5. Maintain a professional image and provide excellent customer service.

6. Attend department meetings and education sessions. Meet/exceed performance expectations within required timeframes.

7. Practice and adhere to the "Code of Conduct" philosophy and Mission and Values statement.

8. Supports special projects as requested. Adheres to all Beaumont Health Business Service Policies and Procedures.

9. Payer training for new hires on Epic, Workqueue’s, payer process, websites and procedures.

10. Performs other duties as assigned.

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

STANDARD REQUIREMENTS:

1. Supports the Mission, Value and Vision of Beaumont Health (BH). Demonstrates personal commitment through active involvement in the performance improvement process.

2. Exhibits excellent customer service skills and behaviors toward internal and external customers and co-workers. Promotes positive public relations with patients/residents, family members, guests, and others.

3. Supports and adheres to all Beaumont Health’s customer service, service excellence, and performance standards. Supports and participates with all required compliance standards that may be department specific and/or identified by the organizations including in-service training, acceptable attendance, uniform and dress code.

4. Adheres to HIPAA requirements and maintains confidentiality of all data, including patient/resident, employee and operations information.

5. Supports and participates in a collaborative team-oriented environment – cooperates and works together with all co-workers, plans and completes job duties, uses appropriate communications in sensitive and emotional situations and follows up as appropriate regarding reported complaints, problems and concerns.

6. Supports, cooperates with and demonstrates safe work practices and attitudes, follows safety rules – including universal precautions - reports and prevents/corrects unsafe conditions and behaviors, and participates in organizational and departmental safety programs.

7. Completes all required compliance standards that may be department specific and/or identified by the organization.

8. Maintains current licensure, registration and/or certification, as applicable, at all times.

STANDARD QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

A. Education / Training:

• High school diploma or GED.

B. Work Experience:

• Minimum of one-year collection experience.

• Relevant education may substitute experience requirement.

• Billing experience, knowledge of UB claims form and knowledge of insurance payment methodologies or knowledge of revenue cycle.

C. Certification, Licensure, Registration:

• None required.

D. Other Qualifications:

• Beaumont Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.