Claims Follow-up Specialist

MOBILE MEDICAL RESPONSE INC•Saginaw Charter Township, MI

4d•Onsite

About The Position

The Claims Follow-up Specialist follows up on Medicare/Medicaid, Blue Cross Blue Shield, Patient Pay, and commercial payer accounts to professionally resolve questions and inquiries from customers and insurance companies. The role supports MMR’s mission, policies, procedures, and standards while maintaining HIPAA compliance. The specialist handles payer follow-up, rejections, denials, appeals, refunds, information requests, returned mail, patient billing information, account resubmissions, and demographic updates. The position also responds to incoming calls, processes credit-card payments, and helps arrange payment in full, payment plans, or charity-questionnaire completion when appropriate. Regular in-person attendance is essential, and work is primarily performed in a typical office setting.

Requirements

High school diploma.
Must be at least 18 years old.
Proficiency with billing Medicare, Medicaid, BCBS, and commercial insurance.
Must proficiently use insurance websites such as C-Snap, Champs, and Web Denis within two months after the date of hire.
Effective professional verbal and written communication in English.
Ability to read and understand correspondence and materials specific to the healthcare industry.
Ability to organize tasks and ensure timely completion of projects.
Advanced computer skills, including use of a PC with a Windows operating system.
Proficiency with Microsoft Word and Excel.
Ability to operate standard office equipment, including a copier, fax machine, scanner, monitor, multi-line telephone, printer, typewriter, and calculator.
Typing, data-entry, scanning, electronic-filing, and document-retrieval skills.
Regular attendance and timeliness; regular in-person attendance is an essential function.
Suitable dexterity to operate standard office equipment and capability to stand or sit for extended periods.
Flexible hours to meet office demands.

Responsibilities

Know and support MMR’s Mission Statement, policies, procedures, and standards.
Maintain HIPAA compliance and the security and confidentiality of information.
Complete Medicare over-50-mile requests and follow up on Medicare and Medicaid rejections, denials, and appeals.
Process Medicare and Medicaid refunds and follow up on missing Medicare signatures by mail or phone.
Answer and assist incoming customer-service calls, including calls from patients, payers, and others.
Process credit-card payments.
Solicit payment in full for services and, when appropriate, establish payment arrangements or request completion of a charity questionnaire.
Contact patients or insurance companies to obtain correct billing information.
Resubmit accounts when new or corrected information is received.
Enter patient demographics based on information gathered through correspondence or telephone contacts.
Complete BCBS/Patient Care Report information requests; process BCBS rejections, denials, and refunds.
Follow up with commercial payers, including auto payers, process returned mail and commercial insurance refunds, and assist with Patient Pay follow-up as needed.
Process Patient Pay returned mail and change-of-address information; place accounts in collections after determining there is no active insurance to bill; and process patient refunds.
Perform other duties as assigned.