Claims Follow-Up Representative (Administrative)

Hospital

The Claims Follow-Up Representative is responsible for monitoring and managing outstanding insurance claims to ensure timely and accurate reimbursement. This role involves investigating and resolving denied or delayed claims, communicating with insurance providers, and maintaining compliance with industry regulations. The ideal candidate has strong analytical skills, attention to detail, and a thorough understanding of healthcare billing processes.

Key Responsibilities:

• Claims Follow-Up: Track and follow up on outstanding insurance claims to ensure prompt payment.

• Denial Management: Analyze claim denials, identify root causes, and take appropriate corrective actions to appeal or resubmit claims.

• Insurance Communication: Contact insurance carriers via phone, email, or online portals to resolve claim issues and obtain payment status.

• Documentation: Maintain accurate records of claim statuses, communications, and resolution efforts in the billing system.

• Compliance: Ensure adherence to HIPAA regulations, payer policies, and industry guidelines.

• Collaboration: Work closely with billing specialists, coders, and other revenue cycle team members to address claim discrepancies.

• Reporting: Generate and review aging reports to prioritize follow-up efforts and track claim resolution progress.

• Process Improvement: Identify trends in denials and delays, providing feedback to management for process enhancements.

• Other duties as assigned.

• High school diploma or equivalent (Associate's or Bachelor's degree in healthcare administration or a related field is a plus).

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

• Knowledge of insurance guidelines, claims processing, and medical terminology.

• Familiarity with Electronic Health Records (EHR) and billing software.

• Strong communication and problem-solving skills.

• Ability to work independently and meet deadlines in a fast-paced environment.

Benefits include:

• Medical, Dental, and Vision
• Generous Paid Time Off and Holidays
• 401K and match start immediately, and includes a generous match
• Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer!