Insurance Follow-up Specialist

ECU Health Medical Center•Greenville, NC

2d•$18 - $26•Remote

About The Position

The Insurance Follow-up Specialist ensures that the healthcare provider and facility receive timely and accurate payments from insurance companies. This position involves thorough follow-up on outstanding claims and working to resolve any issues that may delay payment. The Insurance Follow-up Specialist ensures the efficient management of insurance claims, contributing to the financial stability and operational success of the healthcare provider and facility.

Requirements

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

Nice To Haves

Certified Revenue Cycle Representative (CRCR) preferred.

Responsibilities

Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
Identify and prioritize high-value or aged claims for immediate follow-up.
Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.
Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.
Document all communication and actions taken on each claim in the billing system.
Update patient accounts with the current status of claims and expected payment dates.
Resubmit corrected claims to insurance companies when errors are identified.
Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.
Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.
Assist patients with calling their insurance plans to resolve claim processing issues.
Document detailed and organized follow-up activities, including communication logs, and claim statuses.
Ensure that documentation is complete and compliant with internal policies and external regulations.
Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.
Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.
Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.
Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.
Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.