Insurance Billing & Follow-Up Specialist

ZoomCare•Tigard, OR

4d•$23 - $29•Hybrid

About The Position

At ZoomCare, we are dedicated to making healthcare simple and accessible. Our mission is to provide innovative, high-quality, and convenient healthcare services when patients need them. We offer same-day, no-wait visits across urgent care, primary care, and specialty care, and we are expanding our reach beyond the Pacific Northwest. We are looking for passionate individuals to join our dynamic team. ZoomCare is seeking an Insurance Follow-Up Specialist to join our team! The Follow-up Specialist is responsible for resolving outstanding insurance claims to maximize reimbursement and reduce accounts receivable days. This role involves identifying, researching, and rectifying claim denials and delays for professional services through effective communication with insurance payers and internal departments.

Requirements

High school diploma or equivalent required.
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.
Candidates must reside in Oregon or Washington.

Nice To Haves

Associate’s degree in healthcare administration, Business, or a related field preferred.

Responsibilities

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.
Other duties as assigned.