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Insurance Follow Up Specialist- Senior

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Title: Insurance Follow Up Specialist- Senior

Location: Locations 0126 8431 Fredericksburg Rd, San Antonio, TX, 78229, USs

Job Identification: 5214

Job Category: Finance

Degree Level: HS Graduate or Equivalent

Job Schedule: Full time(Remote)

Job Shift: 8am-5pm Mon-Fri

Job Description:

The Insurance Follow-up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members.

ONSITE TRAINING 4-6 weeks then fully Remote!

Address: 8431 Fredericksburg Rd. , 78229

Responsibilities

  • Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials.
  • Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management teams, and clinical departments.
  • Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.
  • Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility, or additional requests from payors.
  • Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.
  • Work closely with the team to manage high-complexity work queues and claims. Lead special projects to fruition and help define and streamline workflows.
  • Meet or exceed current production standards set by the management team to resolve outstanding claims and maintain healthy accounts receivable.
  • Handle requests from the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations Team to resolve claims and patient or provider issues.
  • Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.
  • Completes all other duties as assigned.

Qualifications

  • Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting is 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 and handle emergent requirements in a timely manner.
  • Able to multi-task in a fast-paced, high-volume environment.
  • Proficient in Microsoft Office software.
  • Medical healthcare records software experience.
  • Experian, Trizetto/Claim Logic experience.

EXPERIENCE:

  • Minimum of five (5) years in a healthcare business office or medical billing-related experience.
  • Hospital experience preferred.

EDUCATION:

  • High School Graduate or Equivalent
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