Insurance Follow-up Specialist

Omega Healthcare Management Services•Boca Raton, FL

1d•Remote

About The Position

The Insurance Follow-up Specialist reviews and manages billing and collections for hospitals and physicians, acting as an intermediary between medical institutions, patients, and insurance agencies. The role supports insurance claim filing, reimbursement and adjustment determinations, write-offs, denial management, benefits analysis, secondary insurance claims, patient statements, and follow-up on submissions. The position operates under limited supervision in a remote home office environment and reports no supervisory responsibility.

Requirements

High school diploma or equivalent.
At least 1–2 years of experience in medical billing or coding.
Knowledge of medical and insurance terminology, including CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible, and co-insurance.
Full understanding of hospital and physician billing.
Experience with standard office software products.
Ability to operate a personal computer and use a variety of software applications.
Ability to prioritize and multitask in a fast-paced, changing environment and meet deadlines.
Analytical, critical-thinking, and problem-solving skills.
Excellent presentation, verbal, and written communication skills.
Leadership, mentoring, interpersonal, and relationship-building skills.
Ability to maintain courteous and professional working relationships at all organizational levels.
Ability to work in all work types and specialties and meet client collection and productivity targets.

Nice To Haves

Knowledge of coding conventions and rules established by AHIMA, the American Medical Association, the American Hospital Association, and CMS for diagnostic and surgical procedural code assignment.
Knowledge of JCAHO, coding compliance, and HIPAA HITECH standards affecting medical records and their impact on reimbursement and accreditation.

Responsibilities

Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
Analyze denied and non-denied 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 them in practice management and internal systems.
Identify potential process improvements, trends, and issues, and escalate them to the supervisor.
Participate in initial and ongoing training to enhance knowledge of revenue cycle management processes.
Investigate complex patient account issues, including system timeline comments, payer reimbursements, and account transactions.
Identify trends and payer issues and escalate complex payer issues to the lead billing specialist as needed.
Maintain working knowledge of client policies and procedures and follow workflow documentation, including SOPs.
Update trackers, issue logs, and trend logs.
Maintain quality standards set by management.
Assist the manager or team lead with priority reports promptly and efficiently.
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 relating to HIPAA and compliance.
Prioritize and manage multiple tasks in a fast-paced, changing environment; work across work types and specialties; and meet goals and deadlines.
Maintain professional relationships and communicate effectively with employees and business partners.
Follow corporate and organizational security policies, safeguard corporate and client assets, and report security compromises within the scope of the position.
Manage individual KRA metrics, understand client requirements, meet targeted collections and productivity goals, follow up on pending claims, and maintain individual status reports.
Perform other duties as directed or assigned.