Insurance Follow Up Rep Lead

Overview

In 2020, united in a fierce commitment to deliver the highest quality care and exceptional patient experience, Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care, including 11 hospitals and nearly 5,000 physicians and providers. Together, we are empowered to make an even greater impact on the health and well-being of our communities.

CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.

As a part of our organization, we currently offer the following benefits:

Competitive starting wages (DOE) and training to grow within the company

Paid Time Off (PTO)

Health/Dental/Vision Insurance

Flexible health spending accounts (FSA)

Matching 401(k) and 457(b) Retirement Programs

Tuition Assistance for career growth and development

Care@Work premium account for additional support with children, pets, dependent adults, and household needs

Employee Assistance Program (EAP) for you and your family

Voluntary Protection: Group Accident, Critical Illness, and Identify Theft

Adoption Assistance

Wellness Program

Responsibilities

Franciscan Medical Group is currently seeking an Insurance Follow Up Rep Lead for the Regional Billing Office in Tacoma, WA. Flexible start times, 5 days a week and no weekends required!

Job Summary:This job is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and denials for the Franciscan Medical Group (FMG) in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues. In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.

The nature of “lead” responsibilities may vary slightly depending on the core job, but generally involves limited oversight over a group of employees that are typically classified in the same core job family. An incumbent performs much the same work as others in the job family, through participation in the day-to-day operations of the work unit, with “lead” work a relatively minor portion of the overall job. Knowledge of the policies, procedures and equipment applicable to the work unit is required.

Essential Duties:

Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is received for all FMG providers.

Identifies potential trends in denials/reimbursement by payer or by type, denial reason, or coding issue and reports to supervisory staff for appropriate escalation.

Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.

Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.

Establishes and maintains professional and effective relationships with peers and other stakeholder

Lead Essential Functions:Note: Incumbents may not perform all of the representative examples of “lead” job duties below, but they must perform a number of them to warrant classification as a “lead”.

Serves as a “lead” resource for other staff in the Follow-Up Representative classification and assists Supervisor/ Manager through the transmission of work instructions and participation in the planning, development, and implementation of new/revised procedures.

Assigns and reviews work to facilitate smooth workflow; assists Manager/Supervisor with hiring interviews, staff orientation/training; provide feedback on staff performance.

Assists with compilation and delivery of staff quality reviews through account reviews and adherence to previously prescribed policies, procedures, and productivity expectations.

Troubleshoots and resolves (within designated scope of authority) more complex problems and/or issues escalated from other staff.

Qualifications

Education/Experience:

Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.

Graduation from a post-high school program in medical billing or other business-related field is preferred.

Additional Minimum Qualifications for lead position:

One additional year of related work experience.

Considerable knowledge of specific policies, standards, procedures and regulatory requirements pertaining to the assigned function.

Ability to act as a resource for staff members and to troubleshoot/resolve difficult and/or unprecedented issues.

Ability to work closely with Supervisor/Manager to devise/implement process improvement initiatives.

Licensure/Certification:Not applicable