Insurance Follow Up Specialist

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. Initiates insurance follow up on unresolved appealed or unpaid claims, to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors.

Submits 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. 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, Tri. Zetto/Claim Logic.

EDUCATION

HS Diploma or GED