Inova Health is looking for a dedicated Patient Financial Services Representative 4 - Insurance Follow Up to join our United Healthcare Payer team. This role will be full-time day shift from Monday - Friday, 8:00am - 5:00pm, Remote Role Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV The Patient Financial Services Representative 4 performs the duties of a Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claim for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Informs management of issues and potential resolutions regarding problems with the claims process. Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: - Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. - Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. - Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. - Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. - Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules Patient Financial Services Representative 4 Job Responsibilities: - Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence. - Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed. - Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity. - Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs. - Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt. - Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards. - Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures. - Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager. - May perform additional duties as assigned. Minimum Qualifications: - Education: Associate Degree or an additional three years of experience appropriate to the position under consideration - Experience: 3 years of Experience in revenue cycle, finance, customer service or data analytics Preferred Qualifications - Expertise in Insurance Follow-Up Authorizations highly preferred. - Proficiency in hospital billing systems (e.g., Epic) and insurance verification portals. - Insurance & Compliance Knowledge: Extensive understanding of Medicaid, Medicare, commercial insurance, and self-pay policies. Familiarity with HIPAA regulations and hospital financial assistance programs. - Analytical & Problem-Solving Skills: Ability to analyze patient accounts, identify discrepancies, and resolve billing or insurance issues effectively. We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. Inova Health System is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.

Manage accurate billing and collection of insurance claims, resolve claim processing issues with insurers, review payments for accuracy, prepare refunds and credit balances, and support team efforts to maintain compliance and patient relations.

Role Description The PFS Medical Insurance Follow-up Specialist I's general responsibilities include but are not limited to: - Accurately following up on medical insurance claims that have been billed to a variety of carriers. - Adequately following up on claims to determine reason for claims denials and work to resolve claim for payment. - Collaborate with various areas of revenue cycle and the organization to ensure accurate and timely follow-up on claims. - Stay current on compliance and payer policies and share information with other caregivers within the organization. Company Description Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care. - Mosaic has a wide array of benefits to meet each employee’s individual needs. - Benefits were designed by listening to people just like you. - Offers several perks with a focus on ensuring employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics, and many more. - When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.

• Contact third party payers to verify eligibility, obtain claim status and take steps to properly resolve CMS 1500/837P claims • Utilize the various internal and online follow up tools provided by Westerkamp Group, LLC and our clients to resolve accounts • Critically analyzing account balances, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), denial reason codes (CARC), and remittance advice remark codes (RARC) on CMS-1500 /837P claim forms to determine the root cause of denials • Maintain workqueues and track trends that can be escalated to management • Clearly notate accounts per Westerkamp Group or client specific standards • Review paper correspondence and take necessary action to resolve insurance payer requests • Analyze and submit cash posting payment and contractual adjustment errors • Ability to adhere to strict compliance guidelines related to HIPAA