Healthcare Outcomes Performance Company the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.

Healthcare Outcomes Performance Company (HOPCo) is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

As HOPCo continues to grow, we are looking for an Insurance Follow-Up Representative in our Corporate Headquarters. Please see below for the functions and requirements for this position.

ESSENTIAL FUNCTIONS

• Reviews insurance denials and rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding denials/rejections.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Verifies receipt of claim with insurance plans, determining the next appropriate action steps and timeliness of claims maximum reimbursement.
• Researches all information needed to complete billing process including obtaining information from providers, ancillary services staff and patients.
• Obtains and attaches referrals/authorizations to appointments/charges.
• Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards.
• Assumes full responsibility of reducing the accounts receivable of insurance balances by working through outstanding accounts.
• Analyzes accounts for proper claims processing and payment posting through inquiries from patients or staff.
• Identifies and communicates trends and/or potential issues to management team.
• Follows and maintains all CORE Institute policies and procedures, including those specific to billing and the Revenue Cycle.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Minimum two to three years of experience in medical billing.
• Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.

KNOWLEDGE

• Knowledge of the physician billing processes, ICD-10 and CPT coding.
• Knowledge of computer systems. Experience with GE patient management system preferred.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skill in customer service and an understanding of The CORE code of conduct and culture.
• Skill in using computer programs and applications including Microsoft Excel, Microsoft Word and Outlook.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Combination of bending, lifting and transferring activities.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be read and signed.

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