3rd Party Follow-up/Denial Representative Job
Full Job Title: 3rd Party Follow-Up/Denial Representative
Job Number: 17010204
Facility: SSM Health System Office
Location: St. Louis, MO
Schedule: Full Time
- Thoroughly reviews accounts and contacts insurance companies for payment on outstanding claims with variances.
- Work daily account as assigned. Take all action necessary to resolve account issues and ensure accurate payment.
- Analyze and research payment variances following up with payer, hospital department, and/or patient to resolve discrepancies.
- Perform all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims.
- Ensure that all activities related to follow up functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
- Daily Focus on attaining productivity and quality standards recommending new approaches for enhancing performance and productivity when appropriate.
- Initiates series of letters and phone calls to guarantor/patients to notify them of rejected claims by their insurance company or requesting them to contact their insurance company to resolve account issues.
- Attend and participate weekly unit meeting. All other meetings as requested.
- Collaborate with claim processing team to ensure prompt and accurate billing and rebilling of insurance claims or will fax claim to payers when requested. Obtain medical records information when requested from the insurance companies.
- Keep team leads/supervisor informed of systems malfunctions, problem areas and other information that would hinder optimal performance.
- Understand all payer guidelines related to insurance follow up; be knowledgeable and proficient with payer websites and other useful resources pertaining to the insurance follow up function.
- Daily focus on complying with policies, processes and department guidelines.
- Requires High School diploma or equivalent
About SSM Health - System Office:
SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God.
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