[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.

Success in this role requires strong knowledge of patient billing, claims submission, payer-specific requirements, denial management, reimbursement practices, and insurance follow-up processes. The Insurance Follow-Up Specialist partners with insurance carriers, patients, clients, and internal revenue cycle teams to resolve claim challenges and maximize reimbursement for our healthcare partners.

Qualifications

• High School Diploma or GED
• 2+ years of insurance follow-up, denials management, medical billing, or healthcare collections experience
• Experience working with Medicare, Medicaid, and commercial payers
• Knowledge of patient billing, claims submission, and denial resolution processes
• Proficiency with Microsoft Office (Outlook, Word, and Excel)

Requirements

• 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.

Benefits

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