Sentara Health is hiring an EMS Insurance Follow-up Representative to manage open Accounts Receivable and drive the resolution of underpayments and denials. In this role, you will work collaboratively with leadership to document follow-up activities, analyze root causes, and ensure accurate revenue cycle management from charge entry to payment review.
What You'll Do
- Review and manage open Accounts Receivable, documenting follow-up activities to resolve underpayments and denials.
- Work claim edit work queues to review, correct, or adjust claims prior to submission to reduce denials and increase reimbursement.
- Conduct root cause analysis of denials and take necessary action to resolve them, escalating accounts to management for contracting action.
- Identify denial and underpayment trends requiring system modifications and recommend corrective action.
- Prepare reports for meetings with provider representatives and senior leadership.
- Apply EMS insurance contract terms to claim payment reviews to determine the source of underpayment.
- Evaluate underpayments related to insurance carrier clinical and payment policies.
- Calculate and submit adjustment and refund requests with appropriate codes and documentation.
- Work on multiple systems including Zoll, EMS Charts, and EPIC PB and HB modules.
- Identify patient out-of-pocket expenses for non-covered services, co-pays, deductibles, and co-insurance.
- Comply with established organizational and departmental policies, procedures, objectives, and goals.
- Collaborate with management to establish issue logs and account examples for insurance carrier meetings.
- Respond to and review all emails and correspondence within 24-48 hours.
- Manage mail from patients and insurance carriers for appropriate distribution.
What We're Looking For
- High School Diploma/GED
- 2 years of professional or facility billing and/or collections for all major third party payers OR work experience in a healthcare related field
- Excellent follow-up and verification skills
- Excellent verbal and written communication skills
- Knowledge of insurance contracts and regulations
- Proficient with Microsoft Excel, Word, and PowerPoint
- Strong analytical, mathematical and organizational skills
- Successful Completion of DOE and Revenue Cycle Education Training within 3 months of hire
Nice to Have
- Associate’s Degree in Health Care Science, Business or related field
- CPAT - Certified Patient Accounting Technician - State of Pennsylvania
Technical Stack
- Zoll
- EMS Charts
- EPIC PB and HB modules
- Microsoft Excel
- Microsoft Word
- Microsoft PowerPoint
Team & Environment
You will work collaboratively with department leadership to review and manage accounts receivable and denial trends.
Work Mode
This is a remote position. Candidates must be located REMOTE IN PENNSYLVANIA.
Sentara Health is an equal opportunity employer. All personnel actions and programs adhere to a policy of non-discrimination regarding race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other protected classes.
