[Hiring] Insurance Follow-Up Specialist @Med A/Rx

Role Description

The Insurance Follow-Up Specialist is responsible for hospital and physician billing follow-up activities focused on resolving unpaid, underpaid, denied, or rejected insurance claims. This role works directly with Medicare, Medicaid, private payers, and commercial insurance carriers to investigate claim issues, facilitate prompt payment, and reduce outstanding accounts receivable.

• Research and resolve denied, unpaid, underpaid, or incorrectly processed insurance claims.
• Investigate claim rejections and denials by contacting insurance carriers and reviewing payer requirements.
• Follow up with Medicare, Medicaid, Blue Cross, and commercial insurance carriers to obtain claim status updates and payment resolution.
• Analyze denial codes, remittance advice, payer correspondence, and claim documentation to identify root causes and determine appropriate next steps.
• Correct claim errors and facilitate claim resubmission to support timely reimbursement.
• Prepare and submit appeals, reconsiderations, corrected claims, and supporting documentation as needed.
• Manage assigned claim inventory and prioritize accounts to reduce aging accounts receivable.
• Contact patients when necessary to obtain or verify information needed to resolve billing or insurance issues.
• Review and update patient demographics, insurance information, and account details when necessary to facilitate claim resolution.
• Document all account activity, payer communications, and claim resolutions accurately and timely.
• Communicate professionally with insurance companies, patients, and client representatives regarding outstanding claims and balances.
• Identify denial trends and recurring issues and communicate findings to leadership and operational teams.
• Meet established productivity, quality, and cash collection performance standards.
• Maintain compliance with HIPAA regulations, client requirements, and company policies.
• Collaborate with Billing, Claims, Collections, and Client Services teams to resolve complex reimbursement issues.

Qualifications

• High School Diploma or GED
• 2+ years of experience in insurance follow-up, denials management, accounts receivable (AR) follow-up, medical billing, healthcare collections, or related healthcare revenue cycle functions
• Experience working with Medicare, Medicaid, and commercial payers
• Experience with hospital billing and/or physician billing processes
• Experience verifying insurance eligibility, benefits, authorizations, and resolving payer-related claim issues
• Knowledge of patient billing, claims submission, reimbursement, denial resolution, and follow-up processes
• Experience using Epic within healthcare revenue cycle systems
• Proficiency with Microsoft Office (Outlook, Word, and Excel)

Requirements

• 3+ years of healthcare revenue cycle, insurance follow-up, denial management, or medical billing experience (preferred)
• Experience in a hospital, physician practice, or healthcare revenue cycle environment (preferred)
• Experience using Cerner, Meditech, or other healthcare information systems (preferred)
• Experience obtaining prior authorizations and navigating payer-specific requirements (preferred)
• Experience utilizing 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 (preferred)

Work From Home Requirements

• A secure and private workspace within their home
• A reliable wired (preferred) high-speed internet connection
• Minimum internet speeds of 30 Mbps download and 10 Mbps upload
• The ability to maintain a professional and distraction-free work environment during scheduled working hours

What We Offer

• Medical, Dental & Vision
• 401(k) with Company Match
• Paid Wellness Time & Holidays
• Employer-Paid Life Insurance & LTD
• Paid Training
• Internal Growth Opportunities