Insurance Follow-Up Specialist

About the Role

The Insurance Follow-Up Specialist is responsible for hospital and physician billing follow-up activities focused on resolving unpaid, underpaid, denied, or rejected insurance claims. This role works directly with Medicare, Medicaid, private payers, and commercial insurance carriers to investigate claim issues, facilitate prompt payment, and reduce outstanding accounts receivable.

The position partners with insurance carriers, patients, clients, and internal revenue cycle teams to resolve claim challenges and maximize reimbursement for healthcare partners.

Responsibilities

• Research and resolve denied, unpaid, underpaid, or incorrectly processed insurance claims.
• Investigate claim rejections and denials by contacting insurance carriers and reviewing payer requirements.
• Follow up with Medicare, Medicaid, Blue Cross, and commercial insurance carriers to obtain claim status updates and payment resolution.
• Analyze denial codes, remittance advice, payer correspondence, and claim documentation to identify root causes and determine next steps.
• Correct claim errors and facilitate claim resubmission to support timely reimbursement.
• Prepare and submit appeals, reconsiderations, corrected claims, and supporting documentation as needed.
• Manage assigned claim inventory and prioritize accounts to reduce aging accounts receivable.
• Contact patients when necessary to obtain or verify information needed to resolve billing or insurance issues.
• Review and update patient demographics, insurance information, and account details to facilitate claim resolution.
• Document all account activity, payer communications, and claim resolutions accurately and on time.
• Communicate professionally with insurance companies, patients, and client representatives regarding outstanding claims and balances.
• Identify denial trends and recurring issues and communicate findings to leadership and operational teams.
• Meet established productivity, quality, and cash collection performance standards.
• Maintain compliance with HIPAA regulations, client requirements, and company policies.
• Collaborate with Billing, Claims, Collections, and Client Services teams to resolve complex reimbursement issues.

Work From Home Requirements

This is a work-from-home position. Employees are expected to perform their job duties from a secure and private workspace within their home that protects confidential company and client information.

Because employees may access protected health information (PHI), financial information, and other sensitive data, work must be performed in an environment where information cannot be viewed or overheard by others.

Employees must have:

• A secure and private workspace within their home
• A reliable wired (preferred) high-speed internet connection
• Minimum internet speeds of 30 Mbps download and 10 Mbps upload
• The ability to maintain a professional and distraction-free work environment during scheduled working hours

Hiring Process and Eligibility

• Candidates will participate in video interviews
• Video interviews may be recorded and transcribed to support candidate evaluation, interviewer collaboration, and hiring decisions
• Candidates may be asked to complete and provide the results of an internet speed test during the interview process
• Candidates must be legally authorized to work in the United States at the time of hire
• The company does not provide employment visa sponsorship
• A pre-employment background check will be conducted
• Candidates residing in New York are not eligible for this position