Insurance Follow-Up Specialist

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

📋 Description

• Conduct research to address denied, unpaid, underpaid, or inaccurately processed insurance claims.

• Investigate reasons for claim rejections and denials by engaging with insurance carriers and reviewing payer guidelines.

• Follow up with Medicare, Medicaid, Blue Cross, and commercial insurance providers to obtain claim status updates and resolve payment issues.

• Analyze denial codes, remittance advice, payer correspondence, and claim documentation to pinpoint root causes and necessary next steps.

• Correct claim inaccuracies and facilitate the resubmission of claims for prompt reimbursement.

• Prepare and submit appeals, reconsiderations, corrected claims, and supporting documents.

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

• Contact patients to gather or confirm information essential for addressing billing or insurance concerns.

• Review and update patient demographic data, insurance details, and account information.

• Accurately and promptly document account activities, payer communications, and claim resolutions.

• Communicate with insurance companies, patients, and client representatives regarding outstanding claims and balances.

• Identify denial trends and recurring issues, communicating findings to leadership and operational teams.

• Meet 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 resolve intricate reimbursement challenges.

• Report directly to the Insurance Supervisor.

⛳️ Requirements

• High School Diploma or GED is required.

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

• Familiarity with Medicare, Medicaid, and commercial payers is essential.

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

• Proven experience in verifying insurance eligibility, benefits, authorizations, and resolving payer-related claim issues.

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

• Experience using Epic within healthcare revenue cycle systems is a plus.

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

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

• Candidates must adhere to work-from-home requirements: secure private workspace, reliable wired high-speed internet is preferred (minimum 30 Mbps download and 10 Mbps upload), and a professional distraction-free environment.

• Candidates must participate in video interviews and may be required to provide internet speed test results.

• A pre-employment background check is necessary.

• Employment visa sponsorship is not available.

• Candidates residing in New York will not be considered.

• 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 environment.

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

• Preferred: Experience in obtaining prior authorizations and navigating payer-specific 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 remote healthcare revenue cycle experience.

🏝️ Benefits

• 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.

• Internal Growth Opportunities.