Insurance Billing And Follow Up Specialist

TEKsystems•Tigard, OR

2d•$24 - $27•Hybrid

About The Position

This role involves processing and submitting insurance claims, following up on unpaid claims, resolving denials, verifying patient coverage, and maintaining accurate documentation. The specialist will navigate payer systems, communicate with insurance representatives, and collaborate with clinical departments to ensure accurate billing and maximize reimbursement.

Requirements

High school diploma required
2+ years of experience in medical billing, with direct experience processing Medicare, Motor Vehicle Accident (MVA), and Workers’ Compensation claims.
Strong knowledge of medical terminology and medical coding systems, including CPT, ICD-10-CM, and HCPCS.
Proficiency in medical billing software and electronic health record (EHR) systems, with the ability to navigate payer portals and claims platforms.
Solid understanding of insurance verification processes, coverage guidelines, and pre-service eligibility checks.
Excellent analytical and problem-solving skills, with keen attention to detail in claim review, denial resolution, and data entry.
Strong written and verbal communication skills, with the ability to communicate effectively with payers, providers, and internal teams.
Ability to work independently, manage competing priorities, and meet deadlines in a fast-paced billing environment.

Nice To Haves

Associate’s degree in Healthcare Administration, Medical Billing, or a related field preferred.
Certification as a Certified Medical Billing Specialist (CMBS) or equivalent credential preferred.

Responsibilities

Process and submit clean insurance claims to Medicare, Motor Vehicle Accident (MVA), Workers’ Compensation, and other insurance payers, ensuring accuracy and compliance with payer requirements.
Conduct thorough follow-up on unpaid, denied, or rejected claims to maximize reimbursement and resolve outstanding balances promptly.
Research, analyze, and resolve claim denials by identifying root causes and implementing corrective actions, including timely appeals when necessary.
Verify patient insurance coverage and benefits prior to service to ensure eligibility and accurate billing.
Maintain detailed and accurate documentation of all billing activities, claim statuses, and communications with insurance payers.
Monitor aging reports regularly, prioritizing follow-up actions based on claim age, payer responsiveness, and filing deadlines.
Navigate complex payer systems and portals to check claim status, update information, and facilitate payment resolution.
Communicate professionally and effectively with insurance representatives to address payment issues, clarify policies, and negotiate resolutions.
Collaborate with clinical departments and providers to obtain additional documentation or correct coding as needed to support claims.
Stay current with insurance billing regulations, payer-specific guidelines, and coding updates to ensure ongoing compliance and optimal reimbursement.
Other duties as assigned.