RCM Account Follow-Up Representative

The RCM Account Follow-Up Representative manages outstanding medical insurance claims within the organization's electronic health record (EHR) and billing systems. This role ensures timely payment from insurance payers by reviewing denied, unpaid, or underpaid claims. The representative investigates billing issues, corrects errors, submits appeals, and updates patient accounts to maximize revenue cycle efficiency.

SPECIFIC SKILLS NEEDED

• Working knowledge of CMS billing and reimbursement rules and commercial payor requirements
• Deep understanding of coordination of benefits (COB) rules and how to determine primary/secondary payor responsibility
• Experience navigating payor portals (including FISS DDE) for eligibility verification, claim status, remittance review, and claim correction/appeal submission
• Strong critical thinking and independent problem-solving skills, with the ability to determine the correct resolution path for a claim rather than following a single fixed script/workflow
• Demonstrated ability to move accounts to resolution – not just document status with a results-oriented approach to aged and complex claims
• Strong written communication skills for appeals and account documentation. EDUCATION/EXPERIENCE/TRAINING Required:
• High School diploma required
• 2+ years of experience in facility claims follow-up, denial management, and/or medical billing/collections Preferred:
• Bachelor’s or associate degree in health care administration, medical billing, or related field preferred.
• Prior experience with Independent Practice/Physician Associations (IPAs)/Health Plan relationships
• Experience working within Epic Resolute Hospital Billing (HB) and/or Professional Billing (PB) Follow- Up work queues
• Familiarity with Epic Claim Status Insights and Follow-Up Activity documentation tools
• Certified Revenue Cycle Representative (CRCR) or similar revenue cycle credential