Insurance Follow-up Specialist

Omega Healthcare Management Services•Boca Raton, FL

2d•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, performs billing and denial follow-up, contacts payers, and works accounts toward payment, adjustment, or self-pay resolution. It also involves investigating complex patient account histories, identifying payer or process trends, maintaining documentation and reports, and meeting client productivity and quality targets. This is a full-time position in a remote home office environment. The schedule is agreed upon with the manager and must fall between 6:00 AM and 9:00 PM PST, Monday through Friday. The position occasionally requires long hours and weekend work, and minimal travel of up to 5% may be required.

Requirements

High school diploma or equivalent.
Minimum 2–3 years of experience in denials management, collections, or accounts receivable follow-up.
At least 2 years of healthcare experience.
At least 2 years of denials and accounts receivable follow-up experience.
Knowledge of medical and insurance terminology, including CPT, ICD-9, ICD-10, HCPCS, copay, deductible, and coinsurance.
Full understanding of hospital and physician billing.
Industry knowledge of guideline requirements for Medicaid, Medicare, commercial payers, and HIPAA.
Experience with standard office software products and proficiency with Outlook and Microsoft Teams.
Ability to operate a personal or company-owned computer and use a variety of software applications.
Ability to prioritize and multitask in a fast-paced, changing environment and work across different work types and specialties.
Ability to self-motivate, set goals, and meet deadlines.
Leadership, mentoring, interpersonal, presentation, verbal, and written communication skills.
Ability to build and maintain relationships with operations business partners through personal credibility and trust.
Ability to maintain courteous and professional working relationships with employees at all organizational levels.
Strong analytical, critical-thinking, and problem-solving skills.

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 the 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.
Investigate complex patient account issues using system timeline comments, payer reimbursements, and account transactions.
Identify trends and payer issues and escalate complex payer issues to the Supervisor as necessary.
Maintain working knowledge of client policies and procedures and follow workflow documentation, including SOPs.
Update trackers, issue logs, and trend logs.
Maintain quality standards established by management.
Assist the Manager or Supervisor in promptly and efficiently working priority reports.
Maintain accurate records in 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.
Prioritize and manage multiple tasks, set goals, meet deadlines, and manage individual KRA metrics.
Meet client productivity and quality targets within the stipulated time.
Follow up on pending claims in a timely manner and prepare and maintain individual status reports.
Safeguard corporate and client assets and take appropriate action to prevent and report security compromises.
Perform other duties as directed or assigned.