Follows up on outstanding payments for open medical insurance claims across managed care and commercial payers. Coordinates with external insurance companies to resolve patient account balances, ensure compliance with managed care guidelines, and support timely reimbursement for the organization.
Key duties include:
- Reviewing unpaid claims, denials, rejections, and underpayments
- Investigating patient accounts with incomplete or incorrect information
- Contacting patients, guarantors, payors, and other parties to resolve balances
- Researching correspondence and complex account issues
- Identifying trends and reporting problematic issues to management
- Correcting charges and contractual allowances within authority
- Documenting claim and payment status in online systems and electronic files
- Supporting special projects, analyses, audits, and cross-training as needed
Requirements & Qualifications
Education and experience:
- High school diploma or GED required
- Two or more years as an Account Follow-Up Specialist, or comparable medical insurance or healthcare billing experience
Skills and knowledge:
- Thorough knowledge of electronic billing systems
- Understanding of medical terminology, CPT, ICD-9-CM, DRGs, and UB-04 claim forms
- Knowledge of contract management systems and Blue Cross / Tricare guidelines
- Basic computer skills, including Microsoft Word and Excel preferred
- Strong prioritization, organization, critical thinking, and problem-solving skills
- Excellent communication skills, including telephone etiquette
- Keyboarding and basic math skills
Location
Illinois, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago