Insurance Follow-Up Representative

Healthcare Outcomes Performance Company•Jacksonville, FL

4d•Onsite

About The Position

Southeast Orthopedic Specialists is seeking Insurance Follow-Up Representatives for their Central Business Office in Jacksonville, FL. This is a full-time, non-clinical role focused on ensuring proper reimbursement for the practice by managing patient accounts and interacting with insurance payors. The company is a regional leader in musculoskeletal medicine, established in 2001, and aims to make five-star orthopedic care accessible to a wide patient base.

Requirements

Minimum of two years of medical claims processing experience.
Ability to read and understand the Explanation of Benefits and denial reasons.
Advanced computer knowledge, including Windows-based programs such as Word and Excel.
Experience working with Blue Cross/Blue Shield, Commercial insurance companies, and Workman's Compensation carriers.

Responsibilities

Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor.
Appeal claims that have been denied for no auth, medical necessity, etc.
Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement.
Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts.
Communicate with payors through phone calls, emails, and payor portals.
Process and take action on any written correspondence from insurance payors.
Identify and trend reasons for claim denials.
Resolve claim discrepancies reported by patients and other clinical departments.