Specialist, ProFee Follow Up

Follow Up Specialist

Follow Up Specialists will work on electronic denial, paper denials and unpaid claims reports to resolve any claims that are denied or unpaid by all insurance carriers. The Specialist will be responsible for forwarding denials to other departments throughout the company so the claims can be handled properly. The Follow Up Specialist will utilize several resources to resolve unpaid claims by online portals, contact via telephone, corresponding via email and appealing claims when needed.

Duties and Responsibilities:

Electronic Denials:

• Correct/Resubmit claims in the clearinghouse portal and in the billing system.
• Direct rejected claims to other departments for resolution if warranted.
• Identify denial trends and report to lead for review to assist in preventing future denials.
• Open cases and work directly with the clearinghouse when claim rejections are being received in error.

Denials:

• Review denied claims for correction/resubmission.
• Direct denied claims to other departments when warranted.
• Utilize multiple online websites and portals for payers to research denied claims.
• Identify denial trends and report to lead for review to assist in preventing future denials.

Aging AR Over 60:

• Follow up on unpaid claims with insurance carriers after a specified claim age.
• Contact insurance companies via telephone, portals, and email requests to inquire on claims denied in error or on claims where there is further information needed to resolve for payment.
• Utilize multiple online websites and portals to research claims.
• Identify denial trends and other issues with insurance carriers and report to lead for review to assist in preventing future denials.
• Process appeals on denied claims.

Knowledge, Skills, and Abilities:

• Basic Medical Billing Knowledge.
• Basic Health Insurance Carrier billing & reimbursement policies.
• Problem solving & dispute resolution.
• Ability to multitask and adapt to changing regulations.
• Strong verbal and written communication skills.
• Excellent organizational and time-management abilities.
• Proficiency in using all Microsoft Office apps such as Teams, Outlook, and Excel.
• Ability to handle multiple tasks and prioritize effectively.
• High attention to detail and problem-solving skills.

Work Experience, Education and

Certifications:

• 1-2 years' experience in an AR Follow-Up
• Experience in Professional CMS 1500 Billing, Multiple Clearinghouses, Billing Systems, EMR's
• Knowledge of Multiple States Billing Requirements, Commercial and Government Payers

Working Conditions and

Physical Requirements:

• 100% Remote
• Expected to work from a designated home office or other quiet and secure location, free from distractions.
• Access to a suitable workspace that includes reliable internet access.
• Ability to sit for long periods while working at a desk or computer.
• Regular use of a keyboard, mouse, and other computer peripherals.
• Occasional video conferencing, which may involve sitting or standing for meetings.

Travel Requirements:

• 0%