Insurance Follow-up Rep

All candidates MUST live in the state of Colorado.

Job Title: Insurance Follow-Up Specialist
Location: Remote (Colorado only)
Shift: 7:00 AM - 3:00 PM MST or 6:00 AM - 2:00 PM MST

Job Description:
We are seeking a detail-oriented Insurance Follow-Up Specialist to join our team remotely, specifically for Colorado residents. This role is responsible for managing hospital claims and working across various commercial payors, including Aetna, UHG, BCBS, Humana, and CIGNA.

In this role, you will focus on keeping accounts receivable (AR) current, reducing delinquency, and managing new referrals. You'll pull ARs based on the assigned segmentation, prioritize actions from oldest to newest, and take the necessary steps to ensure resolution.

Key Responsibilities:

• Segment AR by Payor:
  Work on assigned AR based on segmentation:

  • Keeping AR current
  • Reducing delinquency
  • Managing new referrals

• Account Prioritization & Action:
  Review accounts and take the appropriate action:

  • No action
  • Patient responsibility
  • Re-bill
  • Handle denials or reconsiderations
  • Make adjustments and adjudicate claims

• Commercial Payor Expertise:
  Work with all commercial payors, including Aetna, UHG, BCBS, Humana, and CIGNA. Familiarity with handling small balance accounts (starting at $1,600 and ramping up to $2,000).

• Metrics & Goals:
  Ensure productivity goals are met:

  • Touch 11-12 accounts per hour, with a daily target of 80-90 accounts
  • Maintain AR over 90 days under 40%
  • Achieve 50% future follow-up rate (accounts pending)
  • Focus on "Results-oriented touches" to drive resolution

• Appeals & Denials:
  While rare, may occasionally need to handle appeals and specific denial types. The majority of the workload involves hospital claims rather than physician claims.

Must-Have Skills:

• Insurance Follow-Up Experience
  Proven experience managing follow-up for commercial insurance, particularly in a hospital setting.
• Technical Proficiency:
  Strong computer skills, EOB (Explanation of Benefits), and UB-04 form expertise.
• Typing & Tech-Savvy Skills:
  Able to quickly navigate systems and process claims efficiently.

Nice-to-Have Skills:

• Experience with systems such as Citrix Cerner, HealthQuest, SSI (Change Healthcare), Nthrive/FinThrive, and Availity (payor portals).
• Familiarity with tools like PaySpan, Echo, and DTI for document management and payor portals.
• Training will be provided for our new billing system, which rolls out in two weeks.

Work Environment & Attire:

• Remote Position (Colorado residents only)
• Business Casual Attire

How to Apply:
If you meet the qualifications and are ready to contribute to a high-performing team, apply today!

Benefits:

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)

• Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)

• 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)

• Short Term Disability Insurance

• Term Life Insurance Plan