Perform follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors. Analyze, screen, and correct claim issues. Process appeals, write-offs, and determine if patient billing is necessary.
- Initiate insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement.
- Submit appeals and reconsiderations on claim denials via practice management systems, payor portals, or mail.
- Analyze daily claim rejections from the clearinghouse, screen claims for pre-authorization, and request or submit medical records.
- Work closely with Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
- Review and respond to insurance correspondence related to recoupments, refunds, eligibility, or additional requests from payors.
- Assist the customer service team in resolving patient billing concerns or disputes.
- Verify patient benefits and insurance eligibility, perform claims status verification, navigate insurance websites for payor guidelines, and communicate findings effectively to insurance companies, management, and clinical departments.
- Complete other duties as assigned.
Requirements & Qualifications
- Some knowledge of patient billing or collection/reimbursement procedures in a healthcare setting preferred.
- Experience in medical claims follow-up functions specific to processing insurance claim appeals for various payors.
- Detail-oriented with the ability to organize, prioritize, and coordinate work within schedule constraints.
- Ability to handle emergent requirements in a timely manner.
- Ability to multitask in a fast-paced, high-volume environment.
- Proficient in Microsoft Office.
- EPIC experience.
- Experience with Experian and TriZetto/Claim Logic.
- High school graduate or equivalent.
Location
San Antonio, Texas, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago