Insurance Follow-Up Specialist

Position Summary:

The Insurance Follow-Up Specialist is a vital member of the Compass Revenue Solutions Collections team, responsible for following up with insurance companies on billed claims regarding claim status and resolution of accounts.

Essential Duties:

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone or online resources.
• Review and understand explanation of benefits, and/or remittances.
• Know where to locate all departmental guides, payer rules, templates and platforms.
• Work on correspondence denials received from clients, internal operations or portals.
• Maintain thorough identification and resolution of problematic claims.
• Utilize specialized knowledge of contracts, regulatory or contractual billings guidelines to determine an account’s ability to pay after initial denial from payer.
• Analyze, identify and resolve issues causing payer payment delays.
• Identify root causes for claim denials, underpayments and document the action taken.
• Identify and notate duplicate billings, coordination of benefits, medical records or clinical documents needed from the payers to expedite payment of insurance claims.
• Communicate with AR Director and Team Lead in identification and resolution of denial trends, including timely escalation, and regular updates.
• Identify and communicate billing discrepancies to Team Lead and AR Director.
• Stay up-to-date and utilize available payer website tools for claim and remittance functions.
• Assist with special projects by utilizing excel spreadsheets, and the ability to communicate results.
• Communicate problems, questions and/or concerns to AR Director timely.
• Keep current knowledge of payer policy updates and internal billing policies and procedures.
• Prioritize workflow and work within deadlines.
• Meet productivity and quality standards as set by management.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Fulfill other requests by AR Director, and/or Team Lead.

This position is available for in-office work for the right candidate.

Minimum Qualifications:

• High School diploma or equivalent – some work history may be able to be substituted if necessary
• Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including insurance companies, office staff, facility operators and other staff as needed

Key Competencies:

• Proven reliability when adapting to new experiences
• Required ability to follow standard operating procedures for role
• Solid understanding of insurance policies or the ability to catch on in a timely fashion
• Must have the ability to multitask and manage time effectively without consistent oversight
• Excellent written and verbal communication skills
• Ability to remain organizationally effective and delegate / complete tasks in a first in first out manner
• Efficient with Outlook / Microsoft Office Suite
• Notating CollabMD of all follow up using the “follow-up management” screen
• Ability to utilize insurance portals to collect basic demographic information such as correct spelling of name, address, policy information, DOB, group number etc. when needed for denials, rejections and other notations as required by insurance
• Completion of other miscellaneous tasks as assigned on an as needed basis
• VOB (verification of benefits) back up when needed

Benefits Include:

• Medical, Dental, Vision, Life
• Employee Assistance Program
• 401k Match
• Paid-Time Off
• Sick Time
• Holiday Pay