Senior Insurance Follow Up Specialist

The Insurance Follow-up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members. 

ONSITE TRAINING 4-6 weeks then fully Remote!

Address: 8431 Fredericksburg Rd. , 78229

• Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting is 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.  
• Able to multi-task in a fast-paced, high-volume environment.  
• Proficient in Microsoft Office software.  
• Medical healthcare records software experience.  
• Experian, Trizetto/Claim Logic experience.  

EXPERIENCE:

• Minimum of five (5) years in a healthcare business office or medical billing-related experience.  
• Hospital experience preferred.

EDUCATION:

• High School Graduate or Equivalent 

• 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, with a focus on complex insurance denials.  
• 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 teams, and clinical departments.  
• Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.  
• Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility, or additional requests from payors.  
• Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.  
• Work closely with the team to manage high-complexity work queues and claims. Lead special projects to fruition and help define and streamline workflows.  
• Meet or exceed current production standards set by the management team to resolve outstanding claims and maintain healthy accounts receivable.  
• Handle requests from the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations Team to resolve claims and patient or provider issues.  
• Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.  
• Completes all other duties as assigned.