Insurance Follow-up Denial Specialist I

Optim Health is focused on patients and families with partners including physicians and a team of employees devoted to patient care. The role protects the financial standing by handling billing, coding verification, collection, payment, and customer service for payer and patient accounts. Responsibilities include processing insurance claims timely, reviewing rejected claims, coordinating with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services to resolve claim errors, handling daily error logs and aging claims, addressing insurance inquiries, and maintaining excellent customer service while adhering to company and legal compliance.

Knowledge and skills include advanced billing procedures, multitasking and prioritization, understanding of the revenue cycle and departmental connections, knowledge of government and managed care payer rules, discretion with confidential information, ability to follow written/verbal directions, proficiency in PC applications, and effective communication.

Preferred education and experience include at least one year in Revenue Cycle or related finance, registration, collections, medical, or contract areas, and a high school diploma or GED.

Duties include working with insurance payers for accurate billing, following up on denials and underpayments, producing written correspondence, reviewing accounts for billing protocols, documenting billing actions and escalations, processing appeals and refunds under supervision, collaborating on process education, mentoring and auditing team work, providing team education on billing and accounts receivable requirements, and adhering to HIPAA regulations in information handling.