Careers At HGS

Insurance Accounts Receivable Follow-up Representative

Job Code : HGS/306
EL PASO | TX Permanent

Job Description

The Insurance A/R Follow-up Representative (IAR Rep) is a performance-based position.  Employees in this position will be responsible for reviewing unpaid, underpaid, denied or unresolved insurance balance patient accounts submitted to various health care payers. The primary focus of the IAR Rep is to review claims for accuracy and completeness, timeliness and correctness of payment from payers, and rebilling / appealing as appropriate to resolve any underlying errors in claims submission and account resolution and meet performance-based goals.



Principal Duties and Responsibilities:

·         As defined by project goals, process at minimum 20 claims per day using the appropriate action and status codes.

·         Meet 97% quality score for all claims processed

·         Reviewing insurance balance patient accounts online in various hospital patient accounting systems to determine status of claims with various payers as assigned (Medicare, Medicaid, Managed Care, or Specialty Payers)

·         Send claims requiring billing or rebilling to biller for submission

·         Retrieving necessary supporting documents for billing and rebilling

·         Identifying errors on  claim forms that prevent the claim from being paid

·         Following up on claims to expedite payment

·         Posting adjustments and resolving credit balances within the scope of the project

·         Resolving rejections and denials through corrections and appeals

·         Follow work place rules such as attendance, break and lunches, and quality measures.

·         Demonstrate professional behaviour and respect towards fellow team members, team leaders, management and overall organization


The above statements are intended to indicate the general nature and level of work being performed by employees within this classification.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job.  Employees in this job may perform other duties as assigned.  In addition to the above, all HGS employees are expected to:

* Promote teamwork and cooperative effort.  * Help train and give guidance to other HGS employees.  * Maintain a clean, safe, and unobstructed work area, and practice good safety habits.  * Provide internal and external customers with the highest quality service.



Minimum jOB Requirements: (Education, Experience, Skills)

·         1 year of hospital billing and/or Medicare/Medicaid claim resolution / follow up experience  

·         Understanding of revenue cycle process for healthcare providers

·         Sound understanding of bill form locators and billing policies

·         Able to communicate orally and in writing in fluent English

·         Excellent communication skills and telephone skills

·         Ability to navigate through different computer systems

·         Ability to research documents and find information

·         Solid problem solving skills to resolve complex customer inquiries.






Customer Orientation

Agent understands the impact of individual performance as it relates to the client program and to meeting/improving targets; understands the client needs and expectations; responds to requests effectively and on time; refers complex questions to a higher decision making level; meets customer needs in a respectful, helpful and responsive manner; works with the team to meet objectives; is open to change and new information.

Communication Skills

Reads account notes and listens to insurance company representatives regarding status of accounts,  and presents appropriate information in a clear and concise manner, both orally and written; able to establish two-way communication with Team Leaders.

Work Ethic

Ability to direct oneself towards meeting one’s daily, weekly and monthly goals; understands goals and works towards achieving them; asks for clarification regarding expectation about what/how things need to be done before starting work; takes ownership for work; is open to new ideas; complies with rules and processes; appropriate dress; demonstrates behaviors consistent with the organization’s values; treats others with respect; understand and follows ethical guidelines; regularly shares expertise with team members to support continuous learning and improvement; works well with others, promotes teamwork.

Job Knowledge

Demonstrates basic knowledge and ability to use various applications/tools related to the function; is aware of metric goals; has the knowledge of policies, procedures and regulatory compliance; can identify problems/issues and tries to improve this based on program knowledge; requests help to understand complex issues; identifies problems and escalates accordingly.




HGS is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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