Insurance Follow-Up Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate and address insurance claim denials, typically handling between 50 to 100 denials each day.

• Collaborate with payers to resolve issues and ensure timely reimbursements.

• Analyze LCD/NCD requirements and manage denials related to CPT/HCPCS.

• Work with front desk and authorization teams to minimize delays and enhance collections.

• Provide telephone support to patients, insurance providers, and internal teams.

• Operate within payer portals such as NaviNet, Availity, Medicare portals, and clearinghouses to guarantee efficient claim submissions.

• Conduct prompt and compliant follow-ups to achieve revenue cycle objectives.

⛳️ Requirements

• Minimum of 5 years of experience in healthcare billing, claims processing, or insurance follow-up.

• In-depth understanding of ICD-10, CPT, HCPCS, and the nuances of payer policies.

• Practical experience with Medicare collections for specialty drug coverage, including the use of Medicare portals and the filing of determinations and appeals.

• Demonstrated success in collections with Blue Cross payers; preference given to BCBS FL, Independence BC, and BCBS TX.

• Experience with Medicaid and various commercial insurance plans.

• Knowledge of reimbursement regulations, managed care contracts, and strategies for denial resolution.

• Detail-oriented with strong analytical and critical thinking abilities.

• Proficient in Microsoft Office Suite, including Outlook, Teams, and Excel.

• A proactive team player committed to patient-centered outcomes.

🏝️ Benefits

• Medical, Dental, and Vision Coverage.

• Prescription Drug Coverage and Telemedicine Services.

• Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), and Flexible Spending Options.

• 401(k) Retirement Plan with Company Match.

• Life, AD&D, and Disability Insurance.

• Accident, Critical Illness, and Hospital Indemnity Coverage.

• Fertility and Family Planning Support.

• Tuition Reimbursement and Certification Assistance.

• Continuing Education and Professional Development Resources.

• Employee Assistance Program and Wellness Support.

• Paid Time Off.

• Volunteer Time Off and Charitable Giving Match.

• Employee Referral Bonus Program.

• Flexible fully remote or hybrid work options available for local employees.