Position Summary
Follows up on claim denials and overdue insurance balances using Explanation of Benefits (EOB) documents and reports. This role is assigned a specific book of business based on financial class and payer mix and supports field teams with claim denial resolution.
Key Responsibilities
- Follow up on denied claims and claims with no response in a timely manner.
- Submit appeals related to contract rate variances and discrepancies in allowed amounts.
- Send medical records when requested by payers for claims processing determinations.
- Monitor and review payer correspondence from lockbox and fax channels.
- Monitor, review, and respond to hub/field communication inquiries within the 48-hour requirement.
- Use aged accounts receivable reports to contact payers or check claim status online for unpaid insurance claims.
- Document responses and follow-up activity in the system notes.
- Maintain detailed knowledge of practice management and other computer systems used in the role.
- Respond to written and telephone inquiries from insurance companies.
- Build and maintain relationships with personnel from assigned carriers.
- Meet regularly with leadership to discuss reimbursement and insurance follow-up concerns.
- Attend meetings and continuing education as requested.
- Complete assigned training on time, including CPR, OSHA, HIPAA, compliance, and information security.
- Follow company policies, comply with the Code of Conduct, and report policy violations appropriately.
Requirements & Qualifications
Qualifications
- High school diploma or GED required.
- College education or trade school preferred.
- Previous medical billing and collections experience preferred.
- Minimum of 18 months of experience preferred.
- Comfortable using email and internet-based applications.
- Knowledge of practice management and Microsoft processing software.
- Understanding of Explanation of Benefits forms, claim forms, and insurance billing processes.
- Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.
- Basic knowledge of CPT and ICD-10 coding.
- Strong written and verbal communication skills.
Location
North Carolina, US
Employment Type
Not specified
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago