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Insurance Follow-Up Representative

4 months ago

Menomonee Falls, United States Pride Health Full time

Insurance Follow-Up Representative


Pride Health is hiring an Insurance Follow-Up Representative for one of its clients in Wisconsin.

This is a 3-month contract with a possible extension with competitive pay and benefits.


Job Title: Insurance Follow-Up Representative

Pay range:$20 - $25 per hour (Depending upon relevant experience)

Location: Menomonee Falls, Wisconsin (53051)

Duration: 3 months (possibility of extension)

Shift: M-F flexible


Job Summary

Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.


Job Duties

  • Answers patient calls and research and responds to patient concerns within 24 working hours.
  • Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule, and surgical group methodologies.
  • Applies knowledge for accurate resolution of claims within contract terms.
  • Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Manual), HMO/PPO agreements, and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals.
  • Serves as backup to the person primarily on taking incoming calls.
  • Monitors queue light to ensure minimal wait times for patients in the call queue.
  • Identifies denial trends and reports issues to the Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons.
  • Participates in cross-training efforts for specific systems based on goals set by the PFS department.
  • Addresses account qualifying to a workstation within one week utilizing system-specific follow-up procedures.
  • Coordinates efforts with ancillary departments as needed promptly for effective resolution.
  • Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients.
  • Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions.
  • Updates and verifies payor-specific account information.


Education, Experience, and Skills:

  • A High School diploma or equivalent is required.
  • Five years of experience in billing, customer service, or collections in a healthcare environment is required.
  • Three to four years of leadership experience is required.
  • Previous supervisory experience is preferred.
  • Demonstrated skills in planning, directing organizing, and implementing projects.
  • Recent experience in healthcare reimbursement and knowledge of medical coding and billing.
  • Problem-solving and well-developed analytical skills are required.
  • Effective written and verbal communication skills.
  • Well-developed personnel management and leadership experience.
  • Experienced user of Excel and Word


“Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, , legal support, auto ,home insurance, pet insurance, and employee discounts with preferred vendors. “