Claims Follow Up Rep
3 weeks ago
Remote Schedule
Summary:
Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital.
**Responsibilities**:
Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct. Review claim forms for all required data fields depending on the specific 3rd party requirements. Review patient account for demographic accuracy.
Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data.
Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer’s contracts or Federal reimbursement methods. Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment. Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language.
Continually maintains knowledge of payer specific updates via payer’s listservs, provider updates, webinars, meetings and websites.
Review payer’s settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer’s policies and each individual related contract.
Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.
Understands and maintains compliance with HIPAA guidelines when handling patient information
Initiate adjustments to payer’s as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials. Submits appeals to payers as appropriate to recover denied revenue
Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown.
Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies.
Answer telephone inquiries from 3rd parties and interdepartmental calls. Refer all unusual requests to supervisor.
Retrieve appropriate medical records documentation based on third party requests.
Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations.
Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations.
Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures.
Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates.
Perform other related duties as required.
WORK LOCATIONS/EXPECTIONS:
After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure..
Full time schedule worked in office
Full time schedule worked in a dedicated space in the home
Part time schedule in office and in a dedicated space within the home
Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed.
Other information:
BASIC KNOWLEDGE:
Equivalent to a high schoo
-
Providence, United States LifeSpan Full timeSummary: The Supervisor of PFS reports to the PFS Manager in charge of Denials Follow-Up Credit Balances and Contract Management. Responsibilities: Provides direction in day-to-day operations implements approved follow up procedures ensuring all Lifespan claims activities are carried out in a timely and effective manner. Ensures all procedures are...
-
Providence, United States LifeSpan Full timeSummary: The Supervisor of PFS reports to the PFS Manager in charge of Denials Follow-Up Credit Balances and Contract Management. Responsibilities: Provides direction in day-to-day operations implements approved follow up procedures ensuring all Lifespan claims activities are carried out in a timely and effective manner. Ensures all procedures are...
-
RI/CO Claims Analyst
1 month ago
Providence, United States QBE Insurance Group Full timePrimary Details Time Type: Full timeWorker Type: EmployeeProviding delivery of RI/CO claims services, determining proper policy coverage to conclude, investigate, evaluate and negotiate assigned cases. Ensuring customer satisfaction and equitable solution to RI/CO claims in accordance with company guidelines. Responsibilities: • Support the implementation...
-
Denials Appeal Rep TC
2 weeks ago
Providence, United States Lifespan Corporation Full timeSummary: The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Lifespan policies and procedures performs all administrative/clerical support duties needed to maximize reimbursement from contracted payers. Executes the appeal process by receiving assessing...
-
Denials Appeal Rep TC
2 days ago
Providence, United States Lifespan Corporation Full timeSummary: The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Lifespan policies and procedures performs all administrative/clerical support duties needed to maximize reimbursement from contracted payers. Executes the appeal process by receiving assessing...
-
Customer Service Rep
2 weeks ago
Providence, United States Coastal Consultants , LLC Full timeAn Entry Level Customer Service and Sales Associate is what we call a forward-thinking, service-oriented, incentive-driven, sales powerhouse. They provide an essential function to our customers. Our reps think outside the box to offer solutions and solve problems for our client's needs. They build, maintain, and manage account relationships through...
-
Customer Service Rep
1 month ago
East Providence, United States TONI GROUP LLC Full timeLocation East Providence, RI **IMMEDIATE NEED!** Customer Service Rep needed for growing global automotive manufacturer. **REQUIREMENTS:** The requirements for this position are 5+ years experience in a customer service role for a manufacturer, Ideally seeking someone with experience in automotive manufacturing industry. **RESPONSIBILITIES:** * Timely...
-
Customer Service Rep
2 weeks ago
Providence, United States Coastal Consultants Full timeJob DescriptionJob DescriptionAn Entry Level Customer Service and Sales Associate is what we call a forward-thinking, service-oriented, incentive-driven, sales powerhouse. They provide an essential function to our customers. Our reps think outside the box to offer solutions and solve problems for our client's needs. They build, maintain, and manage...
-
Customer Service Rep
2 days ago
Providence, United States Coastal Consultants Full timeJob DescriptionJob DescriptionAn Entry Level Customer Service and Sales Associate is what we call a forward-thinking, service-oriented, incentive-driven, sales powerhouse. They provide an essential function to our customers. Our reps think outside the box to offer solutions and solve problems for our client's needs. They build, maintain, and manage...
-
Patient Accts Rep Amb Ed
2 weeks ago
Providence, United States Rhode Island Hospital Full time**Summary**: General supervision but according to established credit policies and procedures interviews and registers patients for Emergency/Trauma Center or Ambulatory treatment by obtaining demographic third-party insurance and related financial information entering same to on-line computer system. Completes third-party documentation discusses any existing...
-
Providence, United States Intercity Paper Company, Inc. Full timeIntercity Paper Company is a Janitorial & Maintenance supply distributor serving our commercial clients in RI and Sourthern MA. We are looking for new sales reps to join our team to tackle our RI & MA territories. This position has many opportunities to scale and to make a good income. This is a salary and commission based position. The position is to look...
-
Customer Experience Representative- Remote
2 weeks ago
Providence, United States UNFI Full timeUNFI is looking for a Customer Experience Representative to join their team. UNFI is North America’s Premier Food Wholesaler. We transform the world of food for our associates, customers, suppliers, and the families we serve every day. With deeper full store selection and compelling brands for every aisle, built on an unmatched heritage in great food and...
-
Client Rep cables medior
2 weeks ago
Providence, United States VINCI SA Full timeCLIENT REP CABLES MEDIOR required by our Client, within the Renewables industry, to be assigned on a Contract basis, located in Rhode Island. Duration: 12 months POSITION SCOPE * Rotation: 4 weeks on/off . than the contract start date. * Scopes of work can include: Cable Installation & Cable burial / Survey * Vessels used for the above scopes: Aurora &...
-
Client Rep cables medior
2 days ago
Providence, United States VINCI SA Full timeCLIENT REP CABLES MEDIOR required by our Client, within the Renewables industry, to be assigned on a Contract basis, located in Rhode Island. Duration: 12 months POSITION SCOPE * Rotation: 4 weeks on/off . than the contract start date. * Scopes of work can include: Cable Installation & Cable burial / Survey * Vessels used for the above scopes: Aurora &...
-
Client Rep cables medior
3 weeks ago
Providence, United States Vinci Full timeCLIENT REP CABLES MEDIOR required by our Client, within the Renewables industry, to be assigned on a Contract basis, located in Rhode Island. Duration: 12 months POSITION SCOPE Rotation: 4 weeks on/off . than the contract start date. Scopes of work can include: Cable Installation & Cable burial / Survey Vessels used for the above scopes: Aurora &...
-
Client Rep cables medior
2 weeks ago
Providence, United States Vinci Full timeCLIENT REP CABLES MEDIOR required by our Client, within the Renewables industry, to be assigned on a Contract basis, located in Rhode Island. DURATION 12 months POSITION SCOPE Rotation: 4 weeks on/off . than the contract start date. Scopes of work can include: Cable Installation & Cable burial / Survey Vessels used for the above scopes: Aurora & Deep...
-
Providence, United States Fidelity Investments Full timeCustomer Experience Rep Fidelity Investments Providence, United States Customer Experience Rep Fidelity Investments Providence, United States Posted 4 days ago Permanent Competitive Customer Experience Rep Job Description: Customer Relationship Advocate Career Development Experience Join our team of Customer Relationship Advocates (CRA) for a variety-filled...
-
Denials Appeal Rep TC
2 weeks ago
Providence, United States Lifespan Corporation Full timeSummary: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font: minor-latin;color:black;mso-themecolor:text1">The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Lifespan policies and procedures performs...
-
Denials Appeal Rep TC
3 days ago
Providence, United States Lifespan Corporation Full timeSummary: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font: minor-latin;color:black;mso-themecolor:text1">The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Lifespan policies and procedures performs...
-
Offshore Wind Construction Rep
1 month ago
East Providence, United States TRC Companies, Inc. Full timeAbout Us: Groundbreaker. Game changer. Pioneer. TRC has long set the bar for clients who require more than just engineering, combining science with the latest technology to devise innovative solutions that stand the test of time. From pipelines to power plants, roadways to reservoirs, schoolyards to security solutions, clients look to TRC for breakthrough...
