Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patient’s and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
The Follow Up Representative will be responsible for investigating and examining denial accounts, will apply appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved accounts, provides feedback to the appropriate staff on where the process went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply to the positions entailed duties and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims. Follow Up Representative incumbents must be assessed as being resourceful and having extensive knowledge in area applicable to the assigned specialization group. Acts under direct supervision while learning to make complex decisions within the scope of this position.
Responsibilities:
Investigates and examines source of denials utilizing knowledge of charge master, AS4, ICD-10 coding, CPT coding and EDI billing
Reads and interprets expected reimbursement information from EOB’s and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB
Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient’s admission
Works with HIM and PAS across the enterprise in resolving adverse benefit determinations
Work closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner
Performs duties as given by supervisor to fill in where needed
Maintains and follows all HIPAA and confidentiality requirements
Required Qualifications:
High School diploma
Minimum of 1 year of Billing, Cash Posting or similar experience required
Experience with Patient Account troubleshooting required
Ability to work independently
Demonstrated extensive computer skills required
Demonstrated extensive knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third-Party contracts, minimum of two years experience in a specified area
Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators
Demonstrated ability to work successfully in a team setting
Preferred Qualifications:
Minimum of 2-3 years of In-Patient/Long Term Acute Care or Short-Term Acute Hospital Collections experience preferred
Minimum of 1 year of Billing, Cash Posting or similar experience preferred
Experience with Meditech preferred
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:
Comprehensive Medical, Dental, Vision & RX Coverage
Paid Time Off, Volunteer Time & Holidays
401K with Company Match
Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
Tuition Reimbursement
Parental Leave
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.