General Summary

The Insurance Follow-Up Specialist will review outstanding or denied claims taking the appropriate action, including completion of submissions, reconsiderations, appeals, or re-working denials, to ensure payment is received timely.

Essential Functions

1. Research patient accounts to ensure the correct payor is billed.


2. Research payments made to ensure the payor submitted payment according to contract amounts.


3. Review denial lists daily and contact insurance carriers to resolve any issues with billed amounts.


4. Communicate with Providers, or Medical Secretary to assist with appeal language and file appeals timely.


5. Submit medical records or other requested information to the insurance carrier timely.


6. Respond to written or verbal requests from insurance carriers regarding relevant billing questions.


7. Provide reports on claims and escalate advanced denials/claims to the Revenue Cycle Manager.


8. Document conversations and input notes on patient accounts regarding claim status.


9. Other relevant duties as assigned.

 

Supervisory Requirements

This position will not supervise any other staff members.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; handle, or feel objects, tools, or controls; reach with hands and arms; stoop, kneel, crouch, or crawl; and talk or hear. The employee must occasionally lift and/or move more than 25 pounds.