Insurance Follow-up Specialist

Omega Healthcare Management Services • Boca Raton, FL

3d • Remote

About The Position

The Insurance Follow-up Specialist works with insurance companies on behalf of hospitals and physician practices to resolve outstanding claims and account issues. The role reviews claims in practice management and internal systems, conducts payer follow-up, and directs accounts toward payment, adjustment, or self-pay resolution. It also involves investigating complex patient accounts, maintaining accurate records and workflow logs, meeting client productivity and quality targets, and escalating trends or complex payer issues. The specialist participates in initial and ongoing training, maintains knowledge of client policies and procedures, and may mentor and support new employees. The position operates in a remote home office environment and requires use of a computer, phone, and second monitor. The schedule is full-time, Monday through Friday, with work scheduled between 6:00 AM and 9:00 PM PST by agreement with the manager. Occasional long hours and weekend work may be required, and travel is minimal, up to 5%.

Requirements

• Knowledge of medical and insurance terminology, including CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible, and co-insurance.
• Full understanding of hospital and physician billing.
• Industry knowledge of guideline requirements for Medicaid, Medicare, commercial payors, and HIPAA.
• At least 2–3 years of experience in denials management, collections, or accounts receivable follow-up.
• Experience with standard office software products.
• High school diploma or equivalent.
• Ability to prioritize and multitask in a fast-paced, changing environment.
• Ability to work across work types and specialties.
• Ability to self-motivate, set goals, and meet deadlines.
• Leadership, mentoring, and interpersonal skills.
• Excellent presentation, verbal, and written communication skills.
• Ability to build credibility and trust and maintain relationships with operations business partners.
• Excellent analytical, critical-thinking, and problem-solving skills.
• Skill in operating a personal or company-owned computer and using a variety of software applications.
• Ability to work within individual KRA metrics and meet productivity and quality targets.
• Ability to work occasionally long hours and weekends.
• Ability to occasionally lift or move up to 25 pounds.

Responsibilities

• Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
• Analyze denial and non-denial claims in practice management and internal systems and direct them toward payment, adjustment, or self-pay resolution.
• Perform technical billing and denial follow-up on assigned payer claims.
• Contact insurance companies and third parties to resolve claims after reviewing them in practice management and internal systems.
• Identify potential process improvements, trends, and issues and escalate them to the Supervisor.
• Participate in initial and ongoing training sessions to enhance knowledge of revenue cycle management processes.
• Resolve complex patient account issues by investigating system timeline comments, payer reimbursements, and account transactions.
• Escalate complex payer issues to the Supervisor as necessary.
• Maintain working knowledge of client policies and procedures.
• Follow workflow documentation, including standard operating procedures, and update tracker, issue, and trend logs.
• Maintain quality standards determined by management.
• Assist the Manager or Supervisor with priority reports promptly, effectively, and efficiently.
• Maintain accurate records within a collections database.
• Mentor new employees and assist with their training and development.
• Comply with company policies and procedures, including those related to HIPAA and compliance.
• Meet client productivity and quality targets, follow up on pending claims on time, and prepare and maintain individual status reports.
• Safeguard corporate and client assets and take appropriate action to prevent and report security compromises within the scope of the position.
• Perform other duties as directed or assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED