Cerner Commercial Follow Up

CPSI

About The Position

The Cerner Commercial Follow Up Specialist (UB-04) is responsible for managing and resolving outstanding inpatient hospital claims to ensure accurate and timely reimbursement. This role serves as a liaison between hospitals, clinics, insurance payers, and internal revenue cycle teams. The specialist conducts detailed follow-up on unpaid, underpaid, denied, or rejected claims, ensuring proper documentation, correction, and resubmission when necessary. The ideal candidate is highly detail-oriented, organized, and capable of working in a fast-paced healthcare revenue cycle environment while maintaining strong communication with payers and internal stakeholders.

Requirements

1–3 years of hospital claims processing or insurance follow-up experience.
Hands-on experience working with Cerner for UB-04 (inpatient) claims.
Strong understanding of denial management and appeals processes.
Working knowledge of CPT, ICD-10 coding, and medical terminology.
Experience communicating with commercial and government payers.
Understanding of CAS codes and remittance advice interpretation.
Proficiency with computer systems and revenue cycle software.
Strong written and verbal communication skills.
Ability to multitask, prioritize workload, and meet productivity standards.
Responsible handling of confidential patient information.

Nice To Haves

Experience in hospital revenue cycle or accounts receivable follow-up.
Ability to work with high-profile clients and complex payer processes.
Strong analytical and problem-solving skills.
Flexible and adaptable in a dynamic work environment.

Responsibilities

Perform follow-up on outstanding UB-04 (inpatient) claims with commercial and government payers.
Research and resolve denied, rejected, zero-paid, or underpaid claims.
Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to determine next steps.
Post denials to patient accounts using accurate denial reason codes and appropriate CAS codes.
File claim corrections and submit appeals to insurance carriers to secure maximum reimbursement.
Identify billing errors and coordinate corrections prior to resubmission.
Document all follow-up actions, payer communications, and account activity thoroughly in the system.
Communicate with insurance representatives to verify claim status, request reconsiderations, and escalate unresolved issues.
Maintain daily productivity and quality assurance standards as outlined by management.
Assist with backlog projects, including credit balance resolution, unapplied payments research, and account reconciliation.
Serve as a resource to team members regarding payer policies, denial trends, and follow-up strategies.
Participate in team projects and continuous process improvement initiatives.
Maintain confidentiality and protect patient health information in compliance with HIPAA and other regulatory standards.
Stay updated on payer guidelines, reimbursement policies, and regulatory changes.