The Insurance Follow Up Specialist II is responsible for researching and resolving issues with unpaid, denied or rejected insurance claims. This position will take the required actions in order to facilitate prompt payment from the insurance payer. This individual in this role will also work to ensure that billing practices are ethical and in compliance with government regulations and guidelines.
Follow up with insurance companies regarding claims.
Ensure account balances are correct and balances are assigned to the appropriate insurance or patient bucket. Process adjustments or transfers as needed.
Resubmit corrected claims with supporting documentation as appropriate.
Research and review insurance denials from insurance companies.
Complete and submit reconsideration requests or appeals to insurance companies.
Answer questions from patients and third party payers regarding accounts.
Document all follow up activity in EMR.
Review payer reports to make sure all accounts are paid appropriately to reduce the total company accounts receivables.
Regular interaction and investigation of patient accounts in our practice management and EHR software.
Operate in a team oriented work environment.
Perform related duties as assigned within scope of practice.
Responsible for working on complex denials.
Act as a point of escalation and monitor supervisory or secondary work queues.
High school graduate or GED certificate is required.
A minimum of 1 year experience in a physician billing or third party payer environment.
Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate effective communication skills both verbally and written.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)