Insurance Follow-up Specialist

ECU Health Medical Center•Greenville, NC

About The Position

The Insurance Follow-up Specialist submits primary, secondary, tertiary, and corrected claims through electronic billing software; reconciles payer confirmation reports; processes corrections and revalidates claims; and analyzes payer rejections and denials. The role aggressively follows up with third-party payers to collect outstanding amounts, verifies payments for accuracy, pursues underpayments, and negotiates reimbursement rates with non-contracted payers and case managers. It also processes payer and patient correspondence, stays current on relevant billing and reimbursement rules, and performs other related duties as required or requested while demonstrating service excellence. The specialist monitors outstanding claims for timely resolution, prioritizes high-value or aged claims, contacts insurers about unpaid claims, and escalates issues when needed. The role documents follow-up activity and claim status, updates patient accounts, resubmits corrected claims, and collaborates with billing, coding, healthcare providers, and clinical staff to resolve claim issues. It may also assist patients in contacting their insurance plans. Follow-up activities must be documented and compliant with internal policies, applicable regulations, payer requirements, and HIPAA. The specialist identifies process improvements and participates in training and professional development.

Requirements

High school diploma or equivalent or higher.
At least 5 years of experience in A/R follow-up.
Ability to analyze claims, identify issues, and develop solutions.
High accuracy and attention to detail when reviewing and following up on claims.
Strong analytical and problem-solving skills related to claims processing.
Excellent verbal and written communication skills for interacting with insurance representatives, patients, and internal teams.
Understanding of healthcare billing regulations, HIPAA compliance, and insurance guidelines.
Proficiency in payment review systems, hospital information systems, and coding methodologies.
Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards.
Ability to communicate orally and in written form.
Understanding of insurance terms and payment methodologies.

Nice To Haves

Certified Revenue Cycle Representative (CRCR) certification preferred.

Responsibilities

Submit primary, secondary, tertiary, and corrected claims using electronic billing software.
Reconcile payer confirmation reports, make necessary corrections, and electronically revalidate claims.
Analyze payer rejections and denials and take appropriate action.
Aggressively follow up with third-party payers to collect outstanding amounts.
Verify payments using managed care payer software and pursue underpayments.
Negotiate reimbursement rates with non-contracted third-party payers and case managers.
Stay current on rules and regulations affecting billing, reimbursement, and claim submission.
Process correspondence from third-party payers and patients.
Perform other related responsibilities as required or requested and demonstrate service excellence.
Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
Identify and prioritize high-value or aged claims for follow-up.
Contact insurance companies by phone, email, or electronic portals regarding unpaid claims.
Escalate issues to insurance representatives or supervisors when necessary.
Document claim communications and actions in the billing system, including follow-up activities and claim statuses.
Update patient accounts with claim status and expected payment dates.
Resubmit corrected claims when errors are identified.
Work with billing and coding teams to resolve discrepancies and ensure accurate claim submissions.
Communicate with healthcare providers and clinical staff to obtain information or clarification needed for claims processing.
Assist patients in contacting their insurance plans to resolve claim-processing issues.
Ensure documentation is complete and compliant with internal policies and external regulations.
Identify opportunities to improve the efficiency and effectiveness of claims follow-up.
Comply with federal and state regulations, payer-specific requirements, and HIPAA guidelines to protect patient information and maintain confidentiality.
Stay updated on insurance guidelines, billing regulations, and industry best practices.
Participate in training and professional development to maintain and enhance expertise in insurance follow-up procedures.