Medical Insurance Follow-Up Rep

Medical Insurance Follow-Up Rep

Monday-Friday | Full-Time | Temp-Perm | $18-$21/hour DOE

Job Summary:

The Medical Insurance Follow-Up Representative is responsible for managing and resolving outstanding insurance claims to ensure timely reimbursement for healthcare services. This role involves contacting insurance companies, verifying claim statuses, identifying and resolving denials, and ensuring accurate payment posting. The ideal candidate has strong analytical skills, attention to detail, and a solid understanding of medical billing, insurance policies, and reimbursement procedures.

Key Responsibilities:

• Follow up on outstanding insurance claims to ensure timely processing and payment.
• Review and analyze insurance Explanation of Benefits (EOBs) and remittance advices to identify denials, underpayments, or discrepancies.
• Investigate and resolve denied or unpaid claims by working directly with insurance carriers via phone, email, or web portals.
• Submit appeals and corrected claims when necessary, ensuring compliance with insurance guidelines.
• Verify patient insurance eligibility, coverage, and claim status as needed.
• Maintain accurate and detailed records of all follow-up activities and claim statuses.
• Collaborate with billing and coding teams to resolve discrepancies and prevent future claim issues.
• Communicate with patients regarding insurance-related inquiries and balances when required.
• Stay updated on industry regulations, insurance policies, and payer requirements to ensure compliance with billing procedures.
• Meet department goals for claim resolution, collections, and follow-up efficiency.

Qualifications:

• High school diploma or equivalent (Associate’s degree in healthcare administration, business, or related field preferred).
• 1-2 years of experience in medical billing, claims follow-up, or revenue cycle management.
• Knowledge of medical insurance policies, billing guidelines, and reimbursement processes.
• Familiarity with CPT, ICD-10, and HCPCS coding principles.
• Proficiency in medical billing software, EMR/EHR systems, and Microsoft Office Suite.
• Strong problem-solving skills with the ability to analyze and resolve claim discrepancies.
• Excellent communication and negotiation skills for interacting with insurance companies and patients.
• Ability to multitask, work independently, and meet deadlines in a fast-paced environment.
• Understanding of HIPAA regulations and confidentiality requirements.

Preferred Qualifications:

• Experience with Medicare, Medicaid, and commercial insurance payers.
• Certification in medical billing and coding (CPC, CPB, or similar) is a plus.

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1-2 years of experience in medical billing, claims follow-up or revenue cycle management

* All business operations specialists not listed separately.
* Verify accuracy of billing data and revise any errors.
* Resolve discrepancies in accounting records.
* Prepare itemized statements, bills, or invoices and record amounts due for items purchased or services rendered.
* Operate typing, adding, calculating, or billing machines.
* Post stop-payment notices to prevent payment of protested checks.
* Verify signatures and required information on checks.
* Keep records of invoices and support documents.
* Contact customers to obtain or relay account information.
* Perform bookkeeping work, including posting data or keeping other records concerning costs of goods or services or the shipment of goods.
* Track accumulated hours and dollar amounts charged to each client job to calculate client fees for professional services, such as legal or accounting services.
* Review documents, such as purchase orders, sales tickets, charge slips, or hospital records, to compute fees or charges due.
* Fix minor problems, such as equipment jams, and notify repair personnel of major equipment problems.
* Monitor equipment to ensure proper operation.
* Route statements for mailing or over-the-counter delivery to customers.
* Consult sources, such as rate books, manuals, or insurance company representatives, to determine specific charges or information such as rules, regulations, or government tax and tariff information.
* Weigh envelopes containing statements to determine correct postage and affix postage, using stamps or metering equipment.
* Compare previously prepared bank statements with canceled checks and reconcile discrepancies.
* Match statements with batches of canceled checks by account numbers.
* Take orders for imprinted checks.
* Encode and cancel checks, using bank machines.
* Load machines with statements, cancelled checks, or envelopes to prepare statements for distribution to customers or stuff envelopes by hand.
* Compute credit terms, discounts, shipment charges, or rates for goods or services to complete billing documents.
* Update manuals when rates, rules, or regulations are amended.
* Estimate market value of products or services.
* Review compiled data on operating costs and revenues to set rates.
* Answer inquiries regarding rates, routing, or procedures.
* Compile reports of cost factors, such as labor, production, storage, and equipment.
* Create billing documents, shipping labels, credit memorandums, or credit forms.
* Perform general administrative tasks, such as answering telephones, scheduling appointments, and ordering supplies or equipment.
* Return checks to customers or retrieve checks returned to customers in error, adjusting accounts and answering inquiries about errors as necessary.

Salary : $18 - $21