Insurance Follow-Up Specialist

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

📋 Description

• Conduct research and resolve issues related to denied, unpaid, underpaid, or incorrectly processed insurance claims.

• Investigate cases of claim rejections and denials by reaching out to insurance carriers and examining payer requirements.

• Follow up with Medicare, Medicaid, Blue Cross, and other commercial insurance providers to secure updates on claim statuses and payment resolutions.

• Analyze denial codes, remittance advices, payer communications, and claim documents to pinpoint root causes and determine suitable next steps.

• Correct errors in claims and facilitate their resubmission to ensure timely reimbursement.

• Prepare and submit appeals, reconsiderations, corrected claims, and necessary supporting documentation.

• Manage a designated claim inventory and prioritize accounts to minimize aging accounts receivable.

• Contact patients as needed to obtain or verify information essential for resolving billing or insurance concerns.

• Review and update patient demographics, insurance details, and account information when necessary to assist with claim resolution.

• Accurately and promptly document all account activities, payer communications, and resolutions related to claims.

• Maintain professional communication with insurance companies, patients, and client representatives regarding outstanding claims and balances.

• Identify trends in denials and recurring issues, reporting findings to leadership and operational teams.

• Meet set productivity, quality, and cash collection performance benchmarks.

• Ensure compliance with HIPAA regulations, client requirements, and company policies.

• Collaborate with Billing, Claims, Collections, and Client Services teams to address complex reimbursement challenges.

• Report directly to the Insurance Supervisor.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of 2 years of experience in insurance follow-up, denials management, accounts receivable (AR) follow-up, medical billing, healthcare collections, or related revenue cycle functions.

• Familiarity with Medicare, Medicaid, and commercial payer systems is essential.

• Experience in hospital billing and/or physician billing processes is required.

• Proficient in verifying insurance eligibility, benefits, authorizations, and resolving claims-related issues with payers.

• Understanding of patient billing, claims submission, reimbursement, denial resolution, and follow-up procedures.

• Experience with Epic or similar healthcare revenue cycle systems is preferred.

• Proficient in Microsoft Office applications (Outlook, Word, and Excel).

• Must have a secure and private workspace at home.

• Reliable high-speed internet connection is necessary (wired preferred).

• Minimum internet speeds of 30 Mbps for downloads and 10 Mbps for uploads are required.

• Ability to maintain a professional and distraction-free environment during working hours.

• Must be legally authorized to work in the United States at the time of hire.

• Candidates residing in New York are not eligible for this position.

• Successful completion of a pre-employment background check is required.

• Preferred: Over 3 years of experience in healthcare revenue cycle, insurance follow-up, denial management, or medical billing.

• Preferred: Experience in a hospital, physician practice, or healthcare revenue cycle setting.

• Preferred: Familiarity with Cerner, Meditech, or other healthcare information systems.

• Preferred: Experience in obtaining prior authorizations and navigating specific payer requirements.

• Preferred: Experience using payer portals such as Availity, NaviNet, Experian Health, or similar platforms.

• Preferred: Knowledge of medical terminology, CPT, HCPCS, and ICD-10 coding principles.

• Preferred: Previous experience in remote healthcare revenue cycle roles.

🏝️ Benefits

• Comprehensive Medical, Dental & Vision coverage.

• 401(k) plan with Company Match.

• Paid Wellness Time & Holidays.

• Employer-Paid Life Insurance & Long-Term Disability (LTD).

• Paid Training opportunities.

• Potential for Internal Growth Opportunities.

• This is a Work-from-home position.

• Secure and private workspace at home.

• Paid training provided.

• Opportunities for internal advancement.