Remote Insurance Follow-Up Representative - Hospital

About This Role

This role involves the timely and accurate follow-up on outstanding insurance claims for a hospital, analyzing denials, and resolving unpaid or denied claims. The position aims to ensure maximum reimbursement and support providers' overall financial health.

Responsibilities

• Analyze denials to uncover trends and root causes and recommend process improvements
• Contact third-party payers via phone, email, and payer portals to check claim status, resolve denials, and ensure timely payment
• Review and interpret EOBs/ERAs to determine appropriate action steps
• Appeal denied or underpaid claims in accordance with payer policies and hospital guidelines
• Resubmit corrected claims and provide necessary documentation to resolve claims
• Initiate reconsiderations and resubmissions as necessary
• Prepare and submit formal appeals with appropriate documents in compliance with payer deadlines
• Identify underpaid claims based on contract expectations and research/dispute underpayments with payers
• Accurately document all actions taken within the appropriate workflow management system
• Escalate unresolved issues appropriately to ensure timely resolution
• Adhere to Productivity and Quality Standards
• Monitor and maintain aging buckets to meet department KPIs for follow-up turnaround time and A/R days
• Collaborate closely with coding, registration, billing, compliance, and internal teams
• Recommend process improvements based on denial trends and payer behavior
• Support the onboarding of new team members with payer and system specific training

Requirements

• Minimum 3+ years of hospital billing or revenue cycle experience in insurance follow-up, or denial management
• Strong knowledge and understanding of UB-04 claim forms, revenue codes, modifiers, and payer specific rules
• Proficiency in insurance follow-up, denial management, and claims appeals
• Excellent verbal and written communication skills
• Strong analytical and problem-solving abilities
• Ability to meet deadlines and productivity targets in a fast-paced environment
• Understanding of and adherence to HIPAA and compliance requirements
• High school diploma or equivalent

Qualifications

• High school diploma or equivalent required; associate degree preferred.
• Minimum 3+ years of experience of hospital billing or revenue cycle experience in insurance follow-up or denial management.

Nice to Have

• Associate degree
• Experience in utilizing software such as: Epic, Cerner, Meditech, SSI, IDX/Centricity, Athena, Keane, etc.

Skills

* Required skills

Benefits

Certifications