Follow Up Specialist III

The Medical Insurance Follow-Up Specialist ensures timely and effective follow-up on outstanding insurance claims to secure accurate and prompt reimbursement. This role involves analyzing account activity, investigating denied or unpaid claims, and collaborating with insurance payers and internal departments to resolve issues and expedite payment.

About the role

This position reports to the Revenue Cycle/Follow Up Manager. Core responsibilities are consistent across experience tiers, with expectations for increased independence, complexity, and specialization at higher levels.

Responsibilities

• Follow up on assigned insurance claims to ensure timely and accurate payment.
• Review Explanation of Benefits (EOBs) and remittance advice for payment accuracy and claim status.
• Contact insurance companies via phone, web portals, or written communication to resolve claim issues.
• Identify and appeal denied or underpaid claims based on payer guidelines and documentation.
• Collaborate with billing, coding, and clinical staff to obtain necessary documentation for claims resolution.
• Update patient account notes in the billing system with clear and concise follow-up actions and outcomes.
• Monitor aging reports and prioritize work based on payer deadlines and account balance.
• Ensure compliance with federal, state, and payer-specific regulations and policies.
• Meet individual and team performance goals, including productivity and quality standards.
• Participate in departmental meetings, training sessions, and quality improvement initiatives as required.

Requirements

• High school diploma or equivalent required; Associate's degree in healthcare or business preferred.
• Minimum of 2 years of experience in medical billing, insurance follow-up, or revenue cycle operations.
• Knowledge of insurance payer requirements, CPT/ICD coding, and medical terminology.
• Strong understanding of healthcare claim submission and adjudication processes.
• Experience working with electronic health records (EHRs) and billing systems (e.g., Epic, Meditech, Artiva, etc.).
• Excellent verbal and written communication skills.
• Ability to work independently, manage time effectively, and handle multiple priorities.
• Strong analytical and problem-solving skills.
• U.S. Citizenship, naturalized citizenship, or permanent status is required.

Work Environment

• This position is full-time remote eligible, with eligibility determined by Management or Talent Operations.
• Works in an office environment with minimal exposure to adverse conditions such as heat, cold, or extreme noise.
• Routine periods of phone use (headset), sitting, and data entry are required.
• Sedentary in nature with minimal lifting requirements.
• Must be able to finger, grasp, feel, see, sit, hear, and speak.
• All work must be completed within the continental United States, Alaska, or Hawaii.