Insurance Follow-up Specialist

Omega Healthcare Management Services•Boca Raton, FL

2d•Remote

About The Position

The Insurance Follow-up Specialist reviews and manages billing and collections for hospitals and physicians, serving as an intermediary between medical institutions, patients, and insurance agencies. The role supports insurance claim filing, reimbursement and adjustment determinations, write-offs, denial management, benefit-plan analysis, secondary claims, patient statements, and follow-up on submissions. Under limited supervision, the specialist works assigned payer claims toward resolution, investigates complex patient account issues, maintains accurate collection records and status reports, and monitors productivity and collection targets. The position also supports process improvement, training and mentoring, and compliance with company policies, including HIPAA. This is a full-time remote role with a Monday–Friday schedule of 8 a.m.–4 p.m. EST without a lunch break, or 8 a.m.–4:30 p.m. EST with a lunch break. Occasional long hours and weekend work may be required; travel is minimal, up to 5%.

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, copay, deductible, or coinsurance.
Full understanding of hospital and physician billing.
Experience with standard office software products.
Ability to prioritize and multitask in a fast-paced, changing environment and work across work types and specialties.
Ability to self-motivate, set goals, and meet deadlines.
Leadership, mentoring, and interpersonal skills.
Excellent presentation, verbal, and written communication skills.
Ability to build credibility and trust and maintain relationships with business partners and professional working relationships with employees at all organizational levels.
Excellent analytical, critical-thinking, and problem-solving skills.
Skill in operating a personal computer and using a variety of software applications.
Ability to understand client requirements and project specifications and meet collection and productivity targets.
Ability to work occasionally long hours and weekends.
Ability to travel minimally, up to 5%.
Ability to meet the physical demands described for the role, including occasional lifting or moving of up to 25 pounds.

Nice To Haves

Knowledge of coding conventions and rules established by AHIMA, the American Medical Association, the American Hospital Association, and CMS for assigning diagnostic and surgical procedural codes.
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.
Call 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 a supervisor.
Participate in initial and ongoing training to enhance knowledge of revenue cycle management processes.
Investigate complex patient account issues involving system timeline comments, payer reimbursements, and account transactions.
Identify trends and payer issues and escalate complex issues to the lead billing specialist 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 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.
Meet individual performance metrics, targeted collections, and client productivity targets within stipulated timeframes.
Follow up on pending claims in a timely manner and prepare and maintain individual status reports.
Comply with company policies and procedures, including those concerning HIPAA and compliance.
Safeguard corporate and client assets and take appropriate action to prevent and report security compromises.
Perform other duties as directed or assigned.