What are the responsibilities and job description for the Insurance Follow-Up Representative position at ConvenientMD?
At ConvenientMD, we’re on a mission to make good health more convenient for all – working to improve how patients and providers experience healthcare in New England. To support this belief, we’re building a team of dedicated professionals who genuinely care about improving lives, are passionate about work that can make a difference, and are driven to learn from one another.
The Opportunity
The Insurance Follow-Up Representative is a critical member of the healthcare team, responsible for tracking and resolving outstanding insurance claims. This role involves consistent communication with insurance carriers, healthcare providers, and clients to ensure accurate payment and timely resolution of claims. The position ensures adherence to insurance policies and regulatory guidelines, focusing on reducing delays or denials in payments.
Your Impact
Claims Management
The Opportunity
The Insurance Follow-Up Representative is a critical member of the healthcare team, responsible for tracking and resolving outstanding insurance claims. This role involves consistent communication with insurance carriers, healthcare providers, and clients to ensure accurate payment and timely resolution of claims. The position ensures adherence to insurance policies and regulatory guidelines, focusing on reducing delays or denials in payments.
Your Impact
Claims Management
- Review unpaid, underpaid, or denied insurance claims to identify and resolve issues.
- Contact insurance companies to follow up on the status of claims, disputes, and pending payments.
- Monitor and ensure that claims are processed within appropriate timeframes.
- Identify errors in claims submission, such as incorrect coding or missing information, and work to correct them.
- Address and resolve payment discrepancies, adjustments, or rejections by working with the appropriate parties.
- Maintain accurate and up-to-date records of claim statuses, follow-up actions, and communications.
- Ensure compliance with insurance company policies, industry regulations, and billing procedures.
- Stay informed about changes in insurance regulations and claims processing requirements.
- Maintain confidentiality and follow all legal and regulatory guidelines regarding claims and patient information.
- Work closely with other departments to resolve issues or expedite claims.
- Collaborate with medical providers, insurance adjusters, and other stakeholders to ensure claim accuracy and timely resolution.
- Review and prepare claims for appeal when necessary, ensuring all required documentation is submitted.
- Follow up on appealed claims and ensure timely response from insurance companies.
- Education: High school diploma or equivalent required; associate degree or certification in healthcare administration or insurance is a plus.
- Experience: 2-5 years of experience in claims follow-up, insurance billing, or related roles.
- Strong understanding of insurance policies claims processes, and medical billing codes (if applicable).
- Proficiency in Microsoft Office Suite, especially Excel and Word.
- Excellent communication, analytical, and problem-solving skills.
- Attention to detail with the ability to manage multiple claims simultaneously.
- Capability to work under pressure and meet deadlines.
- Experience with insurance claims, appeals and denials.
- Familiarity with ICD-10, CPT, and HCPCS codes.
- Experience with specific insurance carriers or industry-specific systems.
- Collaborative team environment that encourages professional growth
- Urgent care services at no cost to our team members and their families
- Extensive benefit offerings including health, dental, and vision coverage, company paid short-term disability, and optional pet insurance
- 401k match after one year of service
- Access to our primary care (depending on location)
- Educational Alliance with Purdue University Global and reduced tuition rates for team members and their families
- Employer rewards and access to discounts offered on services and products such as hotels, travel, entertainment, restaurants, and more
