Insurance Follow-up Specialist

Omega Healthcare Solutions•Boca Raton, FL

4d•$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 patient account issues. The role analyzes claims in practice management and internal systems, conducts technical billing and denial follow-up, and moves claims toward payment, adjustment, or self-pay resolution. The specialist investigates complex accounts, identifies payer and process trends, maintains accurate records and workflow documentation, and escalates issues as needed. The position also supports priority reporting, quality and productivity targets, ongoing training, and the mentoring and development of new employees. Work is performed remotely from a home office, with a schedule agreed upon with the manager within the stated operating hours. The position requires occasional long hours and weekend work, and up to 5% travel.

Requirements

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.
Industry knowledge of guideline requirements for Medicaid, Medicare, commercial payers, and HIPAA.
Minimum 2–3 years of experience in denials management, collections, or accounts receivable follow-up.
Experience with standard office software products.
High school diploma or equivalent.
Ability to prioritize and multitask in a fast-paced, changing environment and work across different 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 operations business partners and colleagues at all organizational levels.
Excellent analytical, critical-thinking, and problem-solving skills.
Skill in operating a personal or company-owned computer and using a variety of software applications.
Ability to meet the physical demands described, including occasional lifting or moving of up to 25 pounds.

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 payers and third parties to resolve claims after reviewing them in practice management and internal systems.
Identify 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 using system timeline comments, payer reimbursements, and account transactions.
Escalate complex payer issues to the Supervisor as necessary.
Maintain working knowledge of client policies and procedures and follow workflow documentation, including SOPs, trackers, issue logs, and trend logs.
Maintain quality standards established by management.
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.
Perform duties in compliance with company policies and procedures, including HIPAA and compliance requirements.
Manage individual KRAs according to provided metrics and meet client productivity and quality targets within stipulated timelines.
Follow up on pending claims in a timely manner and prepare and maintain individual status reports.
Protect corporate and client assets in accordance with security policies and report security compromises within the scope of the position.
Perform other duties as directed or assigned.