Medical Insurance Follow-Up Specialist
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Job Description
Medical Insurance Follow-Up Specialist ensuring timely resolution of insurance claims. Investigating and resolving issues with Blue Cross Blue Shield accounts.
Responsibilities:
- Conduct detailed analysis and follow-up on outstanding insurance claims (both commercial and government), ensuring timely and accurate resolution in accordance with payer guidelines.
- Research and resolve claim denials, rejections, and underpayments by initiating appropriate billing corrections, appeals, and resubmissions.
- Prepare and submit claim documentation—including EOBs, itemized statements, and medical records—as required by payers to support claim adjudication.
- Respond to payer and patient inquiries related to delinquent claims, maintaining compliance with privacy regulations and payer contract guidelines.
- Utilize payer portals, Electronic Health Records (EHR), and patient accounting systems to investigate claim status, post notes, and manage follow-up activities.
- Identify trends in denials and payment delays, contributing to process improvement initiatives and strategies for reducing AR days.
- Maintain accurate and detailed records of account activity, ensuring that production goals and quality standards are consistently met or exceeded.
- Demonstrate strong communication skills when interacting with insurance representatives, patients (as appropriate), and internal departments to resolve outstanding issues.
- Prioritize and organize daily workload effectively to meet departmental benchmarks in a fast-paced, high-volume environment.
- Provide support on special projects and additional assignments as requested by management
Requirements:
- 2 years of previous experience working with commercial or other third-party insurance claims, medical billing/follow-up, BCBS experience is a plus
- An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice
- EPIC experience preferred but not required
- Certificates, Licenses, Registrations, and/or Medicare certification are a plus, but not required
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