Software Guidance and Assistance, Inc.
Follow-up Representative
Software Guidance and Assistance, Inc., Emeryville, CA, United States
Software Guidance & Assistance, Inc., (SGA), is searching for a Follow-up Representative for a Contract assignment with one of our premier Healthcare clients in Emeryville, CA .
Responsibilities :
- Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide).
- Make daily inquiries on unresolved invoices by phone or via the internet.
- Interpret account information and enter important details to provide an audit trail for further follow up.
- Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS.
- Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines:
- CCI edits
- UCSF Contract Report
- Profee Grid
- Medicare Fee Schedule
- Cascading guidelines
- CPT, ICD-10, HCPC, Medical Terminology Manuals.
- Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX.
- Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, and commercial insurance.
- Initiate Charge Correction request.
- Submit requests to department via RFI (Request for Information) process and review response for appropriate action.
- Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
- Complete and submit refund request with detailed back-up to the unit manager for approval.
- Effectively communicate with MGBS peers, payers, patients, UCSF departments Leads, Assistant Managers and managers. .
- Utilize knowledge of various systems including, but not limited to:
- Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up.
- Other Follow Up Duties May include:
- Secure guarantor/patient demographic and /or insurance information as required.
- Process correspondence as required in accordance with departmental procedures.
- Billing or rebilling corrected claims.
- Create Orthopedic DME (Durable Medical Equipment) Invoice form for DME billing attachment
- Notify manager of possible procedural change for improving efficiency.
- Perform other duties as assigned.
- Perform Special Projects or Other Duties as Assigned by the Assistant Manager or Manager
- Attend and be engaged in monthly CQI and KPI (monthly one on one) meeting and unit and team meetings aimed at increasing knowledge.
- At least 1 year of previous Insurance Follow up experience.
- Epic Resolute Professional Billing experience
- Experience in medical billing, with a preference for Professional Fee (ProFee) billing
- Familiarity with payer websites and payer provider services
- Demonstrate the Ability to communicate effectively (orally and written).
- Knowledge of CPT and ICD-10
- Experience With Denials Management
- Experience with MS EXCEL and OUTLOOK.
- Effective Time Management and Ability to Meet Deadlines
- Ability to work independently or as needed with a team.
- Ability to meet productivity and quality standards.
- Demonstrates positive attitude and excellent customer service skills.
- Proven ability to coach and mentor staff for optimal results
- Ability to set priorities, goals and objectives
- Demonstrate the ability to perform all aspects of billing and follow-up with superior quality.
- Excellent Attendance Record.
Preferred Skills:
- Prior working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s).
- Certified Procedural Coder (CPC)
- High School Graduate or GED equivalency
- Associates or Bachelor's Degree
- Insurance claims follow-up experience/ Denial management experience
- Knowledge of Medi-Cal managed care processes
SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work. Please find us at https://sgainc.com/ .
SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company EEO page to request an accommodation or assistance regarding our policy.