Join the hospital trusted by Chicago's Southland, Ingalls Memorial Hospital, in this role as a Insurance Collections Representative - Medicare Representative in our Finance department. As a Insurance Collections Representative - Medicare Representative, this position is responsible for collections and final resolution of insurance claims assigned to their respective work list. This role maintains records and reports in accordance with department procedures, meets productivity and quality standards, governing the collection process as defined by the hospital procedures.Ingalls Memorial Hospital serves Chicago's south suburbs. Our patient financial services staff are here to help you navigate the financial aspects of your health care — from bill payment to financial assistance. We are also committed to delivering the best quality with the lowest total cost.This team is dedicated to the accurate and secure resolution of patient accounts. If you're detail-oriented and self-motivated, this will be the ideal team for you.
The Insurance Collections Representative - Medicare Representative is responsible for collections and is responsible for contacting third parties, insurance companies, attorneys and patients in an effort to collect payments due for services rendered. Follow up will be done on a daily basis on the system generated follow up rules. Follow-up work is usually sorted in an alpha split with the expectation of a team effort to achieve department goals. System documentation and contact with insurance companies through telephone and websites is expected as part of the follow-up procedures. Familiarity of Payer contracts filing rules and guidelines. Understanding of each assigned payers expected reimbursement for service rendered by Ingalls Memorial Hospital.
Essential Job Functions
- Utilize the system generated work list assigned to follow-up and resolve accounts.
- Contact assigned Payers to determine when claim will be paid;
- Document account activity accurately and timely, using comments and coded comments as instructed by the follow-up procedures for the PFS department.
- Review payment denials and discrepancies identified on the encounter and take appropriate action.
- Contact patient when required for additional information to allow for claim to be processed.
- Work with PFS management to improve processes to achieve department goals.
- Attend required training as required by department supervisor and hospital policies.
- Maintain proficiency and level of knowledge with all systems required for task completion.
- Documents all actions regarding account resolution in a comprehensive and concise manner and in accordance to department requirements
- Demonstrates improvement in areas outlined in the QA process.
- Looks outside own duties by assisting other staff in meeting and exceeding department and customer needs and expectations
- Working with payers to resolve issues and facilitate prompt payment of claims.
- Thorough knowledge and understanding of billing, claims submission and payer specific requirements is a must.
- This position is highly focused on the resolution of insurance processing errors and denials.
- Payers include but are not limited to Blue Cross, Commercial, Managed Care insurance carriers and Medicare.
- Identifying and resolving all outstanding issues preventing claim resolution.
- High school graduate or equivalent is required
- Two year hospital business office experience preferred
- Ability to interpret contracts, state and federal programs to determine proper reimbursement
- Comprehensive knowledge of insurance plans and payer contracts
- State and Federal regulations regarding HIPPA, billing and collection
- Understanding of CPT, UB-04, HCFA and 837 terminologies
- Medicare, Medicaid and Managed Care Billing/Denial Representatives – Requires 1-2 years prior experience working directly with Medicare/Medicaid Claims
- Knowledge of Microsoft Excel, Word and Outlook
- Typing 30 words per minute
- Ten key calculators
- Demonstrates good verbal, written, and comprehension skills
- Ability to follow and complete detailed directions
- Supports an environment of team work
- Ability to work independently as well as part of a team
- Associate's degree in business, healthcare, or related field required or a combination of relevant education and experience
- Medical Terminology
- Medicare/Medicaid, Managed Care and third party guidelines in a hospital environment.
- Experience with Passport, NEBO, FSS0 and Soarian Financials
- Job Type: Full Time
- Shift: Day Shift
- Department: Revenue Cycle Management
- CBA Code: Non-Union
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