What are the responsibilities and job description for the Insurance Follow-up Specialist position at ECU Health?
ECU Health
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Position Summary
The Insurance Follow-up Specialist ensures that the healthcare provider and facility receive timely and accurate payments from insurance companies. This position involves thorough follow-up on outstanding claims and working to resolve any issues that may delay payment. The Insurance Follow-up Specialist ensures the efficient management of insurance claims, contributing to the financial stability and operational success of the healthcare provider and facility.
Responsibilities
Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
Identify and prioritize high-value or aged claims for immediate follow-up.
Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.
Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.
Document all communication and actions taken on each claim in the billing system.
Update patient accounts with the current status of claims and expected payment dates.
Resubmit corrected claims to insurance companies when errors are identified.
Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.
Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.
Assist patients with calling their insurance plans to resolve claim processing issues.
Document detailed and organized follow-up activities, including communication logs, and claim statuses.
Ensure that documentation is complete and compliant with internal policies and external regulations.
Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.
Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.
Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.
Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.
Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.
Minimum Requirements
Required Education/Course(s)/Training:
High school diploma/equivalent or higher
5 years of experience in A/R follow-up
Required Certification/Registration: None
Certified Revenue Cycle Representative (CRCR) preferred.
Skill Set Requirement
Ability to analyze claims, identify issues, and develop solutions.
High level of accuracy and attention to detail in reviewing and following up on claims.
Strong analytical and problem-solving skills to identify and resolve issues related to claims processing.
Excellent verbal and written communication skills for effective interaction with insurance representatives, patients, and internal teams.
Understanding of healthcare billing regulations, HIPAA compliance, and insurance guidelines.
Proficient in payment review systems, hospital information systems and coding methodologies.
Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards
Communicate orally and in written form.
Understand insurance terms and payment methodologies.
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Position Summary
The Insurance Follow-up Specialist ensures that the healthcare provider and facility receive timely and accurate payments from insurance companies. This position involves thorough follow-up on outstanding claims and working to resolve any issues that may delay payment. The Insurance Follow-up Specialist ensures the efficient management of insurance claims, contributing to the financial stability and operational success of the healthcare provider and facility.
Responsibilities
Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
Identify and prioritize high-value or aged claims for immediate follow-up.
Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.
Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.
Document all communication and actions taken on each claim in the billing system.
Update patient accounts with the current status of claims and expected payment dates.
Resubmit corrected claims to insurance companies when errors are identified.
Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.
Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.
Assist patients with calling their insurance plans to resolve claim processing issues.
Document detailed and organized follow-up activities, including communication logs, and claim statuses.
Ensure that documentation is complete and compliant with internal policies and external regulations.
Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.
Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.
Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.
Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.
Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.
Minimum Requirements
Required Education/Course(s)/Training:
High school diploma/equivalent or higher
5 years of experience in A/R follow-up
Required Certification/Registration: None
Certified Revenue Cycle Representative (CRCR) preferred.
Skill Set Requirement
Ability to analyze claims, identify issues, and develop solutions.
High level of accuracy and attention to detail in reviewing and following up on claims.
Strong analytical and problem-solving skills to identify and resolve issues related to claims processing.
Excellent verbal and written communication skills for effective interaction with insurance representatives, patients, and internal teams.
Understanding of healthcare billing regulations, HIPAA compliance, and insurance guidelines.
Proficient in payment review systems, hospital information systems and coding methodologies.
Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards
Communicate orally and in written form.
Understand insurance terms and payment methodologies.
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
