Insurance Specialist IIIApply Job ID 17882677784 Location Hendersonville, TN Company Name Xtend
Xtend Healthcare, LLC, is located just 20 miles north of Nashville, Tennessee, Xtend provides entirely revenue cycle-based projects which range from complete business office outsourcing to A/R legacy cleanup, self-pay and third-party CBO safety net engagements as well as coding and consulting engagements.
Our founders and senior management have been involved in revenue cycle management for more than three decades. In fact, Xtend's founders are regarded as pioneers in the field. We serve clients of all types and sizes in all 50 states -- from critical-access hospitals to those with more than 2,000 patient beds, and from individual facilities to multi-hospital, university-affiliated health systems.
We are the fastest growing company in the revenue cycle industry. Since 2009, Xtend has grown from fewer than 50 employees to more than 800, which include staff in our central office, our team of traveling consultants, and employees in our four service centers in the Nashville area. We perform 100 percent of our work in the USA.
In 2015, Xtend was acquired by Navient which is the nation's leading loan management, servicing and asset recovery company. By joining forces with Navient, the Xtend team will be bolstered by the strength, stability and resources of an industry leader, and leverage the parent company's large scale business process outsourcing capabilities.
Xtend Healthcare is looking for Insurance Specialists to be responsible for review and resolution of outstanding insurance balances on hospital or physician patient accounts. The Insurance Specialist will be required to have flexibility to learning and comprehending complex hospital systems and keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client and federal guidelines.
1. Effectively manages assigned insurance receivables to achieve business line expectations.
- Meets or exceeds productivity standards as outlined by business line.
- Achieves or exceeds at least 85% work quality scoring and accuracy on all accounts worked.
- Completes timely follow-up on assigned accounts to ensure no cash loss.
- Meets or exceeds monthly cash expectations as set out for assigned client receivables.
- Ensures insurance accounts are resolved within 90 days of placement.
- Demonstrates the ability to prioritize work with some oversight to meet outlined goals.
2. Perform account research and route accounts through appropriate client workflows.
- High level understanding of client host system functions.
- Clearly documents actions taken and next steps for account resolution in patient accounting system.
- Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system.
- Demonstrates advanced understanding of commercial and Medicaid payers.
- Has knowledge of Medicare guidelines and is able to accurately perform corrections according to CMS guidelines.
- Demonstrates advanced understanding of claim needs and ability to accurately perform needed billing activities (Evaluation/Correction of billing edits, claim transmission, rejections, and other claim functions.)
- Compiles appeals and approves appeal requests for team related to technical payment denials.
- Demonstrates the ability to act as request approver for team members to ensure accurate actions are taken for account resolution.
- Reflects understanding of payer contract verbiage and the ability to negotiate payment utilizing contract terms.
- Ensure strong communication skills to convey intricate account information.
3. Ensure all accounts are worked within client standards and Federal Regulations.
- Maintain high quality account handling per client standards.
- Work within federal, state regulations, department/division & all Compliance Policies.
- Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications.
4. Maintain continuing education, training in industry career development.
- Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
- Attend training sessions as directed by management.
- Integrate information obtained through training sessions and policy changes immediately into daily routine.
- Other duties as assigned.
- High school education or equivalent.
- 1+ years of experience in a healthcare receivables environment.
- Organization and planning skills.
- Oral and Written Communication skills.
- Basic Computer skills.
- Familiar with widely used patient accounting software.
- Data management.
- Attention to detail and accuracy.
- Problem solving capabilities.
- Adaptability and flexibility.
KNOWLEDGE, SKILLS and ABILITIES:
- Possess excellent reading and writing skills.
- Strong Computer skills.
- Ability to communicate successfully with patients, hospital or Xtend Employees.
- Is able to work individually and as part of a team.
- Possess ability to concentrate for long periods of time.
- Proficient in numeracy skills.
- Pays close attention to detail.
- Must possess excellent grammar and spelling skills.
- Proficient in knowledge and use of email and internet.
- Possess above average knowledge of administrative procedures.
keywords: patient account representative, billing specialist, medical biller, Medicare, Billing Manager, collections specialist, refund analyst