Learn more at. POSITION SUMMARY: The Insurance A/R collections specialist is responsible for processing all activity related to OSS's patient accounts receivable. Patient accounting functions supported include billing, follow-up, collections, patient concerns, cash application, and credit balance resolution.
Performs other work associated with the billing process. SUMMARY OF DUTIES: Review patient financial information to verify third-party payer requirements have been met and financial coding is correct; Audit information on third-party claim forms for accuracy and completeness; transmit claims to third-party payers, including using a direct entry claims interface system; Prepare and
input allowances and adjustments to patient accounts according to third-party payer requirements and department procedures; Access major payers' computer files online to obtain eligibility and claims processing information; Respond to inquiries from patients, third-party payers and agencies, and other departments; Analyze unpaid third-party claims to determine appropriate follow-up action to assure payment; Analyze third-party contract reimbursement for accuracy; Contact patients and payers by telephone to resolve account balances; Process appropriate transactions to correct inaccurate account balances; Prepare correspondence to address account concerns; Analyze delinquent accounts with regard
to billing and payment history and determine appropriate follow-up procedures based on departmental guidelines; Analyze financial information provided by patients to determine their ability to make payments; advise patients on appropriate payment plans; Prepare accounts for transmittal to collection agencies when department collection efforts are determined to be unsuccessful; Process according to department procedure accounts which have been identified as returned mail or bankrupt or deceased patients; Post and balance daily remittances to patient accounts; post allowances and adjustments accompanying cash remittances; Resolve credit balances through allowances, adjustments, or refunds to patients of third-party payers; KNOWLEDGE, SKILLS, AND ABILITIES: Extensive insurance billing, follow-up experience, Previous experience working in health care insurance follow-up (is preferred, but not necessary), Experience in patient accounts receivable/collections (is preferred but not necessary), Strong interpersonal skills, sound judgment & decision-making, Strong analytical skills.
Persuasive customer service skills, Effective written and oral communication skills, Capable of working independently, Ability to prioritize and organize daily tasks, Ability to always represent OSS professionally, Ability to communicate information effectively to payers, clients, and staff, Secure patients' demographics and medical information with great discretion and ensure all procedures align with HIPAA compliance and regulation.
BENEFITS: Check out our benefits page for more information about our Benefits and Rewards. /employee-benefits Matching 401(k) Health Insurance Dental and Vision Insurance Advancement opportunities Company-wide celebrations and events! SCHEDULE: Monday - Friday (no weekends) from 8 am to 5 pm. #OSS001 Job Posted by Applicant Pro
Ensures that group participation requirements are met. Prepare rate filings. Follows underwriting guidelines, policies, procedures and formulas in developing rates for new and renewal groups. Gathers the appropriate data used to determine the status of account refunds.
Maintains spreadsheet information on group renewal history. Prepares memos and other correspondence to communicate changes in rates or benefits which have been approved by underwriting management. Processes the appropriate paperwork associated with renewal rate action and proposal closing. Supports internal sales staff regarding underwriting questions and/or resolves issues. Effectively communicates Underwriting
decisions to other departments when necessary. May determine rates for alternative benefit variations and funding arrangements. Assist in the training process and mentoring of more junior level Underwriters.
Prepares contingent premium settlements. Prepares the rate quotations and completes bid specifications. Processes group financial settlement calculations. Reviews and determines whether or not to grant exception requests. Supports management reporting efforts and the development of automated rating and analysis tools. May determine rates for alternative benefit variations and more complex funding arrangements. Actively involved in the preparation and maintenance of underwriting
guidelines and rating policy. Actively involved with testing new rating, underwriting and front end systems.
Answers questions regarding the basic factors used in developing rates, (group size, type of benefits, age/gender composition, large claims, experience provided from the prior carrier, current rates). Answers questions regarding the rate model and how it impacts rates in accordance with particular group demographic changes. backsses health risk in a group environment (performs large claim analysis for ongoing claim cost). Develops prospective and renewal rates for group accounts in accordance with corporate and underwriting guidelines.
Reviews and determines whether or not to grant exceptions to underwriting policy. Ensures the proper administration of underwriting and legislative guidelines for new and renewing groups. Handles large volume production with account specific issues (I. e. reinstatements, eligibility standards, group identification criteria, etc) Maintains a working knowledge of State and Federal regulations affecting group rating. Prepares rate breakouts and hierarchy definitions for group setups. Reviews and directs the preparation of experience reports for fiscal, ERISA and contingent premium settlements.
May meet with external customers, brokers or account representatives to review underwriting calculations and provide explanations for rating principles. May prepare written summaries of recommendations and/or conditions of coverage for the group after completion of each analysis. May prepare an explanation of the past rating history, documenting benefit and enrollment changes, and providing a recommendation for benefit and financial options. Contribute to timely and accurate productivity by assisting the Manager in education to new Underwriters. Attends broker meetings, as well as meetings with sales executives, agents and/or groups to provide explanations of rating principles or rationale of rating positions.
Contributes to the development of new rating formulas, methodologies and guidelines. Represent underwriting on Cambia workgroups and strategy sessions and serves as department representative where applicable. Responsible for the assignment of workload and ensuring smooth operations. Tracking timeliness and quality of work output. May be responsible for peer review and sign-off. Minimum Requirements Demonstrated analytical and problem solving skills. Business sense including: finance, accounting, economics, and risk management principles.
Effective verbal and written communications. Ability to build and maintain positive internal and external customer interactions. Ability to prioritize tasks and meet deadlines. Demonstrated technology proficiency, including Excel, Word, and applicable software applications. Demonstrated success with managing competing priorities and workload. Demonstrated proficiency working with complex computer software systems and automation. Ability to effectively explain complex mathematical and abstract concepts to a variety of stakeholders, including those with less familiarity and/or understanding.
Proven understanding of business, including: finance, accounting, economics, and risk management. Demonstrated attainment of a high level of independent, consistent performance. Ability to organize, plan, prioritize and complete complex assignments with little or no supervision. Demonstrated ability to read the marketplace and competitive environment. Highly developed business acumen, finance, accounting, economics, and risk management. Demonstrated project management skills of wide-scale. Demonstrated success in oversight of work programs and providing effective guidance on process and practice.
Normally to be proficient in the competencies listed above The Underwriter Lead would have a Bachelor's degree in business, math, statistics or related discipline and a minimum of 8 years related experience or an equivalent combination of education and experience. The expected hiring range for a Underwriter Lead is $88,500.00 - $120,500.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%.
The current full salary range for this role is $83,500.00 to $136,000.00. #LI-remote Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights: medical, dental, and vision coverage for employees and their eligible family members annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date) paid time off varying by role and tenure in addition to 10 company holidays up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period) up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption) one-time furniture and equipment allowance for employees working from home up to $225 in Amazon gift cards for participating in various well-being activities.
for a complete list see our External Total Rewards page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, interaction, interactionual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email xyz X@. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.
