Insurance Follow-Up Representative

Join to apply for the Insurance Follow-Up Representative role at Bayhealth
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4 days ago – Be among the first 25 applicants.

This range is provided by Bayhealth. Your actual pay will be based on your skills and experience—you’ll discuss it with the recruiter.

$17.83/hr - $26.75/hr

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, as well as a stand‑alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties.

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: 30 Old Rudnick Ln

Status: Full Time 80 Hours

Shift: Days

Salary Range: 17.83 - 26.75 (Hourly)

The Insurance Follow‑Up and Collections Representative is responsible for following up on all hospital and/or professional insurance claims. The position requires entry‑level knowledge of all payer and claim types, and the ability to prioritize workflow to meet insurance company filing deadlines for claim submission, claim reconsiderations, appeals, and to achieve targeted receivables on a monthly basis, and expedite cash flow. Specific duties involve researching unpaid claims, responding to insurance company information requests, submitting reconsiderations for partially paid claims, appealing denied claims, and resolving payment variances to facilitate timely patient billing.

• Follows up on unpaid claims and appeals via telephone or web‑based claim inquiries. Completes imaging system correspondence work queue(s) as appropriate. Research missing payments via undistributed work queues and apply payment to correct invoice. Documents accounts thoroughly and appropriately with all information concerning claim and expected payment status and necessary follow up action taken to secure payment.
• Verifies insurance eligibility, corrects claim errors, submits claim reconsiderations, writes appeals, and provides requested information to resolve denied claims. Interacts with various long term care offices to correct denials as appropriate.
• Interprets payer denials, reviews submitted claim information, and medical records to understand the denial. Refers denied claims to the correct department work queue with coding recommendations or other clarification questions as needed to resolve denied claims. Documents inappropriate denials on spreadsheets. Identifies and performs appropriate contract and/or other denial related write offs.
• Contacts patients to resolve insurance company‑initiated information requests as needed to facilitate claim payment.
• Review and interpret contract terms for managed care, commercial care, Medicare, Medicaid, and workers’ compensation as applicable.
• Reviews insurance company payment variances, pursues underpaid claims, and submits over payments for refunds—documents inappropriate payment variances on spreadsheets.
• Processes credit balances; submits over payments electronically to insurance companies who require electronic submission to correct the over payment. As applicable, reviews the third‑party vendor submitted refunds for accuracy.
• Escalates insurance company and internal claim related issues to management as appropriate for resolution.
• Maintains established department productivity minimums.
• All other duties as assigned within the scope and range of job responsibilities.

• Education:
  
  High School Diploma or GED.
• Credential(s):
  None.
• Experience:
  
  No experience required.

Preferred: One year experience in medical billing and collections, medical bad debt collections, or an internship/externship in medical billing related to a certification program.

• Education:
  
  None.
• Credential(s):
  None.
• Experience:
  
  None.