- Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
- The Follow Up Specialists are responsible for organizing and maintaining patient health information. They sort and maintain patient medical data and history of treatment for various uses such as insurance reimbursement and inclusion in databases and registries. Follow Up Specialists ensure health information is accessible but also secure from unnecessary access.
- Establish and maintain security of medical records to ensure patient confidentiality on an ongoing basis.
- Review patient records on a daily basis for accuracy, supply any missing information and ensure compliance with company policy and government regulations.
- Access patient records as needed for review by other staff members.
- Follow professional standards and meet requirements of local, state and federal regulations.
- Encode information accurately from scanned medical images.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within the standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with the contract matrix.
- Calling insurance companies regarding any discrepancy in payments if necessary.
- Identifying and billing secondary or tertiary insurances.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Obtaining referrals and pre-authorizations as required for procedures.
- Ability to multitask
- Accuracy and attention to detail.
- Communication and interpersonal skills.
- Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
- Familiarity with CPT and ICD-10 Coding.
- Effective communication abilities for phone contacts with insurance payers to resolve issues.
- Customer service skills for interacting with insurance phone representatives regarding medical claims and payments.
- Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
- Problem-solving skills to research and resolve discrepancies, denials, and appeals.
- A calm manner and patience working with insurance phone representatives when inquiring about claim status.
- Knowledge of medical terminology likely to be encountered in medical claims.
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
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Follow Up Specialist - Central Luzon, Pilipinas - Ventra Health
Paglalarawan
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