The Insurance Follow-up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members.
Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials.
Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management teams, and clinical departments.
Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.
Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility, or additional requests from payors.
Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.
Work closely with the team to manage high-complexity work queues and claims. Lead special projects to fruition and help define and streamline workflows.
Meet or exceed current production standards set by the management team to resolve outstanding claims and maintain healthy accounts receivable.
Handle requests from the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations Team to resolve claims and patient or provider issues.
Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.
Completes all other duties as assigned.
Minimum of five (5) years in a healthcare business office or medical billing-related experience. Hospital experience preferred.
