Join to apply for the Insurance Follow-Up Specialist role at Bayhealth.
Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Departments in Smyrna and Milton. We offer various practice settings throughout Kent and Sussex Counties, with convenient locations close to major cities and beaches.
We offer a competitive salary and comprehensive benefits package, including:
* Generous Paid Time Off and Holidays
* Matching 401(k)/403(b) Plans
* Health, Dental, and Vision Insurance
* Disability and Life Insurance options
* On-site Child Care
* Educational Reimbursement
* Flexible Spending Accounts for Healthcare and Dependent Care
* Additional voluntary benefits
Location: 30 Old Rudnick Ln
Status: Full Time, 80 Hours
Shift: Days
Salary Range: $19.18 - $28.77 hourly
General Summary
The Insurance Follow-Up and Collections Specialist is responsible for managing all hospital and professional insurance claims follow-up. This role requires advanced knowledge of payers and claim types, prioritizing workflow to meet deadlines, and achieving targeted receivables to facilitate cash flow. Duties include researching unpaid claims, responding to insurer inquiries, submitting reconsiderations and appeals, interpreting denials, reviewing medical records, and resolving payment variances. The specialist also recommends system or process improvements and serves as a subject matter expert on reimbursement and contract requirements.
Responsibilities
* Follow up on unpaid claims and appeals, document account activities, and perform appropriate write-offs.
* Verify insurance eligibility, correct claim errors, submit reconsiderations, and handle denied claims.
* Interpret payer denials, review claim information and medical records, and resubmit claims as needed.
* Convert inpatient admissions to observation claims when approved.
* Communicate with patients regarding insurance inquiries.
* Review regulations and contract terms for various payers.
* Understand contracted reimbursement rates and review payment variances.
* Process credit balances and overpayments.
* Escalate issues to management.
* Provide payer-specific education to colleagues and ensure process improvements.
* Maintain department productivity standards.
* Perform other duties within scope as assigned.
Minimum Requirements
* High School Diploma or GED
* At least three years of hospital and/or physician billing and collections experience
Preferred Qualifications
* Associate Degree
* Certified Revenue Cycle Specialist
* Four years hospital billing or collections experience
For a full list of opportunities, visit: https://apply.bayhealth.org/join/
Additional Information
* Seniority level: Mid-Senior level
* Employment type: Full-time
* Industry: Hospitals and Healthcare
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