Insurance Billing Specialist And Follow Up
About The Position
The Insurance Billing Specialist and Follow Up processes and submits clean insurance claims to Medicare, Motor Vehicle Accident (MVA), Workers Compensation, and other insurance payers, ensuring accuracy and compliance with payer requirements. The role follows up on unpaid, denied, or rejected claims, researches and resolves denials, identifies root causes, and submits appeals when necessary to maximize reimbursement and resolve outstanding balances. The specialist verifies patient insurance coverage and benefits before service, documents billing activities and payer communications, monitors aging reports, and uses payer systems and portals to check claim status and facilitate payment resolution. The role communicates with insurance representatives and collaborates with clinical departments and providers to obtain documentation or correct coding. It also requires staying current with billing regulations, payer guidelines, and coding updates. The position is a contract role based in Tigard, Oregon, with a hybrid workplace arrangement.
Requirements
- High school diploma required.
- At least 2 years of medical billing experience, including direct experience processing Medicare, MVA, and Workers Compensation claims.
- Strong knowledge of medical terminology and medical coding systems, including CPT, ICD-10-CM, and HCPCS.
- Proficiency with medical billing software and electronic health record systems, including the ability to navigate payer portals and claims platforms.
- Understanding of insurance verification processes, coverage guidelines, and pre-service eligibility checks.
- Strong analytical and problem-solving skills, with attention to detail in claim review, denial resolution, and data entry.
- Strong written and verbal communication skills for communicating 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 degree in Healthcare Administration, Medical Billing, or a related field.
- Certified Medical Billing Specialist (CMBS) certification or an equivalent credential.
Responsibilities
- Process and submit accurate, compliant claims to Medicare, MVA, Workers Compensation, and other insurance payers.
- Follow up on unpaid, denied, or rejected claims to maximize reimbursement and resolve outstanding balances promptly.
- Research claim denials, identify root causes, implement corrective actions, and submit timely appeals when needed.
- Verify patient insurance coverage, benefits, and eligibility before service.
- Maintain accurate documentation of billing activities, claim statuses, and communications with payers.
- Monitor aging reports and prioritize follow-up based on claim age, payer responsiveness, and filing deadlines.
- Use payer systems and portals to check claim status, update information, and facilitate payment resolution.
- Communicate with insurance representatives to address payment issues, clarify policies, and negotiate resolutions.
- Collaborate with clinical departments and providers to obtain supporting documentation or correct coding.
- Stay current with insurance billing regulations, payer-specific guidelines, and coding updates.
- Perform other duties as assigned.
Benefits
- Medical, dental, and vision benefits, if eligible.
- Critical Illness, Accident, and Hospital coverage, if eligible.
- 401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
- Voluntary life and AD&D insurance for the employee and dependents, if eligible.
- Short- and long-term disability coverage, if eligible.
- Health Spending Account (HSA), if eligible.
- Transportation benefits, if eligible.
- Employee Assistance Program, if eligible.
- Time off or leave, including PTO, vacation, or sick leave, if eligible.
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What This Job Offers
Career Level
Entry Level
Education Level
High school or GED
