Conduct detailed analysis and follow-up on outstanding insurance claims (both commercial and government), ensuring timely and accurate resolution in accordance with payer guidelines.
Research and resolve claim denials, rejections, and underpayments by initiating appropriate billing corrections, appeals, and resubmissions.
Prepare and submit claim documentation—including EOBs, itemized statements, and medical records—as required by payers to support claim adjudication.
Respond to payer and patient inquiries related to delinquent claims, maintaining compliance with privacy regulations and payer contract guidelines.
Utilize payer portals, Electronic Health Records (EHR), and patient accounting systems to investigate claim status, post notes, and manage follow-up activities.
Identify trends in denials and payment delays, contributing to process improvement initiatives and strategies for reducing AR days.
Maintain accurate and detailed records of account activity, ensuring that production goals and quality standards are consistently met or exceeded.
Demonstrate strong communication skills when interacting with insurance representatives, patients (as appropriate), and internal departments to resolve outstanding issues.
Prioritize and organize daily workload effectively to meet departmental benchmarks in a fast-paced, high-volume environment.
Provide support on special projects and additional assignments as requested by management

2 years of previous experience working with commercial or other third-party insurance claims, medical billing/follow-up, BCBS experience is a plus
An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice
EPIC experience preferred but not required
Certificates, Licenses, Registrations, and/or Medicare certification are a plus, but not required

Insurance Follow-Up Specialist

Key skills