Professional Billing: Insurance Follow-up Specialist

Essential Functions

• Represent our values: Awesome, Creative, Respectful, Team Players, Get it Done.
• Work unpaid and partially paid insurance claims to resolve outstanding balances and secure accurate reimbursement in accordance with payer guidelines.
• Research claim status by utilizing insurance portals, conducting phone outreach, and drafting written correspondence as needed.
• Analyze denied or underpaid claims to identify root causes, trends, and necessary corrective actions.
• Submit timely and well-documented appeals for denied claims in alignment with specific payer policies and appeal procedures.
• Resubmit corrected claims with updated coding, documentation, or demographic information to facilitate proper adjudication.
• Maintain thorough and accurate records of all claim follow-up activities within the billing or revenue cycle management system.
• Collaborate with coding teams, clinical documentation specialists, and provider offices to gather missing information or resolve claim discrepancies.
• Monitor aging accounts and prioritize claims based on timely filing limits and payer response windows.
• Identify systemic issues or process inefficiencies impacting claim resolution and escalate concerns to management with supporting documentation.
• Meet or exceed established productivity and quality benchmarks while adhering to compliance and privacy standards.

Qualifications

• High school diploma or equivalent required; associate’s degree in healthcare administration, Business, or a related field preferred.
• 2+ years of experience in medical billing, with a focus on professional billing and accounts receivable follow-up.
• Solid understanding of CPT, HCPCS, and ICD-10 coding systems and their application in claim submission and reimbursement.
• Experience working with electronic billing systems and payer portals to manage claim status, denials, and appeals.
• Familiarity with insurance reimbursement methodologies, claim adjudication processes, and payer-specific requirements.
• Working knowledge of medical terminology and healthcare documentation.
• Strong analytical and problem-solving skills with the ability to identify issues, evaluate alternatives, and implement solutions.
• Excellent written and verbal communication skills, with the ability to collaborate effectively across teams and with external contacts.
• High attention to detail and accuracy, with proven ability to manage multiple tasks and meet deadlines in a fast-paced environment.

Compensation Package

• Medical, Dental, Vision benefits
• 401K with employer match
• Paid Time Off, Paid Holidays, Paid Parental Leave, Sabbatical Program
• Hourly Pay Rate: $23 - $29/hr
• May be eligible for other compensation such as bonuses

Working Conditions

• Project timelines and work volume/deadlines may often require more than your scheduled hours per week or work outside of regular business hours to complete essential duties of this job.
• Ability to work at a computer/workstation for prolonged periods of time.
• Close and distance vision and ability to adjust focus.
• Seeing, hearing, speaking, and writing clearly to effectively communicate with others.
• Exposure to sensitive and confidential information.
• Occasional reaching and lifting of small objects and operating office equipment.
• On-site presence required a minimum of 3 days per week to support non-electronic processes.
• Remote work available for the remaining workdays.
• Must wear a mask as needed.