Insurance Follow Up Specialist

UT Health San Antonio•San Antonio, TX

About The Position

The Insurance Follow Up Specialist performs follow-up activities on outstanding medical claims for Medicare, Medicaid, commercial, and specialty insurance or program payors. The role analyzes, screens, and corrects claim issues; processes appeals and write-offs; and determines whether patient billing is necessary. The specialist also verifies benefits, eligibility, and claim status, and communicates findings to payors, management, and clinical departments.

Requirements

High school diploma or GED.
Experience in medical claims follow-up, including processing insurance claim appeals for various payors.
Proficiency in Microsoft Office.
EPIC experience.
Detail-oriented, with the ability to organize, prioritize, and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
Ability to multitask in a fast-paced, high-volume environment.

Nice To Haves

Some knowledge of patient billing or collection and reimbursement procedures in a healthcare setting is preferred.
Experience with Experian and TriZetto/Claim Logic.

Responsibilities

Initiate follow-up on unresolved appealed or unpaid claims to support maximum and timely reimbursement from Medicare, Medicaid, commercial, and specialty insurance or program payors.
Submit appeals and reconsiderations for claim denials through the practice management system, payor portals, or mail.
Analyze daily claim rejections from the clearinghouse and screen claims for pre-authorization requirements.
Request and submit medical records.
Work with Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
Review and respond to insurance correspondence concerning recoupments, refunds, eligibility, or additional payor requests.
Assist the customer service team with patient billing concerns or disputes.
Verify patient benefits and insurance eligibility, and confirm claim status.
Navigate insurance websites to identify payor-specific guidelines.
Communicate findings to insurance companies, the management team, and clinical departments.
Complete other duties as assigned.