Medical Insurance Follow-Up Specialist

The Medical Insurance Follow-Up Specialist plays a crucial role in the healthcare revenue cycle by ensuring the timely and accurate resolution of outstanding insurance claims, denials, and aged accounts. As a key member of the accounts receivable team, this position supports hospitals and physician billing departments by managing claim follow-ups, resolving discrepancies, and contributing to overall revenue optimization. With a focus on back-end accounts receivable functions, the Medical Insurance Follow-Up Specialist leverages industry knowledge and technical skills to navigate complex payer systems and claim processes in a fully remote work environment.

This opportunity is ideal for professionals seeking to advance their career in healthcare administration, offering the flexibility of remote work and the chance to make a significant impact on provider financial health.

As a Medical Insurance Follow-Up Specialist, you will be responsible for performing second-tier follow-up activities on insurance accounts, focusing on aged receivables and denial resolution for both hospital and physician billing. The role is designed for detail-oriented individuals with a strong background in healthcare revenue cycle operations and a passion for problem-solving. This full-time position allows you to work remotely, providing essential support to healthcare providers and hospital organizations throughout the revenue cycle process.

The ability to research, analyze, and resolve complex claim issues is essential, as is a thorough understanding of payer guidelines and industry-standard billing forms such as UB-04 and HCFA 1500.

• Conduct follow-up on outstanding accounts receivable balances for both hospital and physician billing.
• Resolve insurance denials, underpaid claims, and unresolved accounts by researching payer guidelines and claim history.
• Analyze aged accounts and address payer issues to ensure timely reimbursement.
• Perform high-dollar account reviews and detailed research to identify and address claim discrepancies.
• Review and verify the accuracy of UB-04 and HCFA 1500 claim forms before submission or correction.
• Investigate and resolve eligibility discrepancies, coding issues, payer denials, and reimbursement variances.
• Communicate professionally with insurance payers, clients, and internal team members to facilitate claim resolution.
• Identify payer trends, workflow challenges, and barriers to resolution, recommending process improvements when necessary.
• Submit corrected claims, rebills, secondary billings, and appeals as appropriate to maximize reimbursement.
• Maintain thorough and accurate documentation of all account activity, correspondence, and actions taken.
• Escalate payer errors for reprocessing as required.
• Work with both commercial and government payers to resolve outstanding accounts.
• Consistently meet productivity and quality standards as established by the organization.

• Competitive hourly wage commensurate with experience and industry standards.
• Comprehensive health, dental, vision, and life insurance coverage.
• Paid time off (PTO), paid sick leave, and paid holidays.
• Opportunities for career growth and professional development within the healthcare revenue cycle sector.
• Remote work flexibility and a supportive team environment.

• 1-2 years of experience in healthcare revenue cycle operations required.
• Experience with hospital billing and/or physician billing is required.
• Strong knowledge of insurance denial management, follow-up processes, and industry-standard claim forms (UB-04, HCFA 1500).
• Proficiency in using electronic health record (EHR) systems such as Epic, Cerner, Meditech, McKesson, Allscripts, Soarian, or similar platforms.
• Excellent computer skills, including Microsoft Office suite and internet-based applications.
• Ability to multitask efficiently across multiple systems and applications.
• High school diploma or equivalent required;
  Associate's or Bachelor's degree preferred.
• Strong communication skills and the ability to collaborate effectively with team members and external partners.

• Detail-oriented professional with a strong understanding of healthcare billing and payer processes.
• Self-motivated and able to work independently in a remote setting.
• Demonstrates excellent problem-solving and analytical skills to resolve complex claim issues.
• Adaptable to changing priorities and able to manage…