EMS Insurance Follow-up Representative

Accounts Receivable Specialist

Imagine a career at one of the nations most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the Best Hospitals by U.S. News & World Report for 23 consecutive years. Were a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Centers prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an A grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHNs commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether youre considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Works collaboratively with department leadership to review and manage open Accounts Receivable, accurately documenting follow-up activities resulting in the resolution of underpayments and denials. Works claim edit work queues to review, correct or adjust claims prior to being sent to insurance to reduce denials and increase reimbursement. Conducts root cause analysis of denials and takes the action necessary to resolve the denial escalating accounts to management that need to be submitted to the provider representative for contracting action. Identifies denial and underpayment trends that require computer system modifications and recommends necessary to implement corrective action. Prepares reports for meetings with provider representative and senior leadership, as required.

Job Duties

• Demonstrates the ability to apply LVHN EMS insurance contracts terms to claim payment reviews and the ability to determine if the source of an underpayment is related to a contract management discrepancy, an underpayment, or a line item denial.
• Demonstrates knowledge of insurance carrier reimbursement requirements to evaluate underpayments that are related to insurance carrier clinical and payment policies.
• Conducts a root cause analysis of denials, taking the appropriate corrective action as required, escalating denial trends to management, and routing denials to the appropriate area for resolution.
• Calculates and submits adjustment and refund requests utilizing the appropriate adjustment code, refund reason, and clearly documents the account history.
• Able to work on multiple systems - Zoll, EMS Charts, EPIC PB and HB modules. Responsible for the entire Rev Cycle including charge entry, verify trip sheet for correct CPT codes, diagnosis and mileage.
• Identifies the patient out of pocket expense related to non-covered services, co-pays, deductible, and co-insurance allocating the patient responsibility to the patient within the timely filing limit.
• Demonstrates knowledge of and compliance with established organizational and departmental policies, procedures, objectives and goals.
• Works collaboratively with management to establish issue logs and account examples for meetings with the insurance carrier provider rep.
• Responds and reviews all emails and correspondence within 24-48 hours, manages mail received from patients and insurance carriers for appropriate distribution.

Minimum Qualifications

Preferred Qualifications

Physical Demands

Lift and carry 25 lbs. frequent sitting / standing, frequent keyboard use,

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and / or social activities.