Insurance Follow Up Specialist

• Job Responsibilities
• Perform follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial and Specialty insurance/program payors.
• Analyze, screen, and correct claim issues.
• Process appeals, write-offs, and determine if patient billing is necessary.
• Submit appeals and reconsiderations on claim denials via practice management system, payor portals, or mail.
• Analyze daily claim rejections from our clearing house, screen claims for pre-authorization, request and submit medical records.
• Work closely with the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
• Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility or additional requests from payors.
• Assist customer service team in resolving patient billing concerns or disputes.
• Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management team, and clinical departments.
• Completes all other duties as assigned.

Requirements

• Some knowledge of patient billing or collection/reimbursement procedures in a healthcare setting preferred.

Experience in medical claims follow-up functions specific to processing insurance claim appeals for various payors.

• Detail oriented with the ability to organize, prioritize and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
• Ability to multi-task in a fast paced, high-volume environment.
• Proficient in Microsoft Office.
• EPIC experience.
• Experian, Trizetto/Claim Logic.

• EDUCATION

• HS Diploma or Equivalent

• Experience

• Three (3) years hospital business office or medical billing related experience.
• Hard Skills
• medical claims follow-up
• claims processing
• appeals processing
• claim analysis
• billing procedures
• insurance eligibility verification
• claims status verification
• pre-authorization screening
• patient billing
• reimbursement procedures
• Soft Skills
• detail oriented
• organizational skills
• prioritization
• coordination
• multi-tasking
• timely handling of requirements
• communication skills
• Industry Keywords
• Medicare
• Medicaid
• commercial insurance
• specialty insurance
• hospital business office
• medical billing
• insurance correspondence
• recoupments
• refunds
• provider enrollment
• Tools & Technologies
• Microsoft Office
• EPIC
• Experian
• Trizetto
• Claim Logic
• practice management system
• payor portals
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