Insurance Follow-up Specialist

Omega • Boca Raton, FL

3d • 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, performs technical billing and denial follow-up, contacts payers, and directs claims toward payment, adjustment, or self-pay resolution. It also investigates complex patient account issues, identifies payer and process trends, escalates issues, maintains records and workflow documentation, and supports training and mentoring. The position is full-time and remote, with a schedule agreed upon with the manager within the hours of 6:00 AM to 9:00 PM PST, Monday through Friday. Occasional long hours and weekend work may be required, and travel is minimal, up to 5%.

Requirements

• High school diploma or equivalent.
• Minimum 2–3 years of experience in denials management, collections, or accounts receivable follow-up.
• At least 2 years of healthcare experience.
• At least 2 years of denials and AR follow-up experience.
• 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; proficiency with Outlook and Microsoft Teams.
• 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, interpersonal, presentation, verbal, and written communication skills.
• Ability to build and maintain relationships with operations business partners and maintain professional working relationships at all organizational levels.
• Ability to follow corporate and organizational security policies and help safeguard corporate and client assets.
• Excellent analytical, critical-thinking, and problem-solving skills.
• Ability to operate a personal or company-owned computer and use a variety of software applications.

Responsibilities

• Work with insurance companies on behalf of hospitals and physician practices to resolve outstanding issues.
• Analyze 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 payers 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.
• Resolve complex patient account issues by investigating system timeline comments, payer reimbursements, and account transactions.
• Escalate complex payer issues to the Supervisor as necessary.
• Maintain knowledge of client policies and procedures, and follow workflow documentation, including SOPs, the Update Tracker, Issue Log, and Trend Logs.
• Maintain management-defined quality standards.
• Assist the Manager or Supervisor with priority reports promptly and effectively.
• Maintain accurate records in a collections database.
• Mentor new employees and assist with their training and development.
• Comply with Company policies and procedures, including HIPAA and compliance requirements.
• Meet client productivity and quality targets, follow up on pending claims, and prepare and maintain individual status reports.
• Manage individual KRAs according to provided metrics.
• 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 eligibility for bonus programs, commissions, or other variable incentive plans

What This Job Offers

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