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.

Success in this role requires strong knowledge of patient billing, claims submission, payer-specific requirements, denial management, reimbursement practices, and insurance follow-up processes. The Insurance Follow-Up Specialist partners with insurance carriers, patients, clients, and internal revenue cycle teams to resolve claim challenges and maximize reimbursement for our healthcare partners.

Title: ​Insurance Follow-Up Specialist​
Location: ​Remote, Work-From-Home​ – ​United States​
Schedule: ​Monday – Friday, 8:00 AM - 5:00 PM Central or 8:00 AM – 5:00 PM Eastern
Department: ​Insurance​
Reports To: ​Insurance Supervisor​
Compensation: ​$18-$22 per hour​

Key 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 appropriate 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 when necessary to facilitate claim resolution.
Document all account activity, payer communications, and claim resolutions accurately and timely.
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.

Required Qualifications:

High School Diploma or GED
2+ years of experience in insurance follow-up, denials management, accounts receivable (AR) follow-up, medical billing, healthcare collections, or related healthcare revenue cycle functions
Experience working with Medicare, Medicaid, and commercial payers
Experience with hospital billing and/or physician billing processes
Experience verifying insurance eligibility, benefits, authorizations, and resolving payer-related claim issues
Knowledge of patient billing, claims submission, reimbursement, denial resolution, and follow-up processes
Experience using Epic within healthcare revenue cycle systems
Proficiency with Microsoft Office (Outlook, Word, and Excel)

Preferred Qualifications:

3+ years of healthcare revenue cycle, insurance follow-up, denial management, or medical billing experience
Experience in a hospital, physician practice, or healthcare revenue cycle environment
Experience using Cerner, Meditech, or other healthcare information systems
Experience obtaining prior authorizations and navigating payer-specific requirements
Experience utilizing payer portals such as Availity, NaviNet, Experian Health, or similar platforms
Knowledge of medical terminology, CPT, HCPCS, and ICD-10 coding principles
Previous remote healthcare revenue cycle experience