Insurance Follow-up Specialist

Omega Healthcare Solutions • Boca Raton, FL

1d • $21 - $24 • 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 technical billing and denial follow-up, and directs accounts toward payment, adjustment, or self-pay resolution. It also investigates complex patient account issues using account timelines, payer reimbursements, and transaction histories; identifies payer trends and process improvements; and escalates issues when needed.

The specialist maintains knowledge of client policies and procedures, follows workflow documentation and tracking processes, maintains accurate collection records, and meets client productivity and quality targets. The role includes participating in ongoing training, helping with priority reports, mentoring and training new employees, and complying with company policies, including HIPAA and security requirements.

This is a full-time remote home-office position. The work schedule is agreed upon with the manager and must fall between 6:00 AM and 9:00 PM PST, Monday through Friday. The position may occasionally require long hours and weekend work, and travel is minimal, up to 5%.

Requirements

• High school diploma or equivalent.
• At least 2–3 years of experience in denials management, collections, or accounts receivable follow-up.
• 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 ability to operate a personal or company-owned computer and use software applications.
• Ability to prioritize and multitask in a fast-paced, changing environment and work across work types and specialties.
• Ability to self-motivate, set goals, meet deadlines, and meet productivity and quality targets.
• Leadership, mentoring, interpersonal, presentation, verbal, and written communication skills.
• Ability to build credibility and trust and maintain professional working relationships with employees at all levels.
• Strong analytical, critical-thinking, and problem-solving skills.
• Ability to safeguard corporate and client assets and follow organizational security policies and procedures.

Responsibilities

• Review 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 insurers and third parties to resolve claims after reviewing practice management and internal system information.
• Investigate and resolve complex patient account issues using system timeline comments, payer reimbursements, and account transactions.
• Identify process improvements, trends, and payer issues and escalate them to the Supervisor as appropriate.
• Participate in initial and ongoing training to enhance knowledge of revenue cycle management processes.
• Maintain knowledge of client policies and procedures and follow workflow documentation, including SOPs, trackers, issue logs, and trend logs.
• Maintain quality standards set by management and meet client productivity and quality targets within stipulated timelines.
• Assist the Manager or Supervisor with priority reports promptly and efficiently.
• Maintain accurate records in a collections database and prepare and maintain individual status reports.
• Follow up timely on pending claims and manage individual key result areas according to provided metrics.
• Mentor new employees and assist with their training and development.
• Comply with company policies and procedures, including HIPAA and security requirements.
• Perform other duties as directed or assigned.

Benefits

• Health coverage
• Dental coverage
• Vision coverage
• Voluntary insurance options
• 401(k) plan with employer match
• Professional development opportunities
• Paid time off
• Holiday pay
• Potential bonus programs, commissions, or other variable incentive plans for eligible employees

What This Job Offers

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