Insurance Follow Up Representative

Location: Remote (CO, MA, NC, GA, FL, TN, TX, KY)
Shift: M-F, 8:00 am - 5:00 pm PST (some flexibilty available here)
Pay: $18-$20
Hospital Support: PST

Job Description Summary:
We are seeking a dedicated Insurance Account Representative to manage a portfolio of accounts within our Client Partner's Government, Non-Government, TPL, or Worker's Compensation Accounts Receivable. This role focuses on rapid, compliant, and patient-centric resolution of balances to maximize financial performance.

Key Tasks and Deliverables:

• Perform follow-ups via website, portal, or phone to collect and resolve assigned insurance balances.
• Leverage knowledge of managed care contracts, payer behaviors, and clean claim statutes to influence Payer intent and overcome payment objections or delays.
• Understand expected reimbursement on assigned Payer(s); identify, resolve, and prevent payment discrepancies.
• Submit/Re-submit UB-04, 1500, and other Claim forms with accurate field locators and required documentation (Itemized Statements, Medical Records, etc.).
• Resolve coverage, coordination of benefits, and authorization issues with Payers and Patients.
• Manage printing and mailing of Claims.
• Consistently document all Payer and Patient encounters in the Hospital's system and Excalibur's workflow solution.

Skill Sets and Experience:

• Proficiency with UB-04 and CMS 1500 forms.
• Comprehensive knowledge of Government and Non-Government payers.
• Experience with EMR systems (Epic, Cerner, Meditech preferred).
• Expertise in insurance follow-up, payer behavior, and guidelines.
• Ability to manage multiple systems efficiently.
• Strong documentation, written and verbal communication skills.
• Proficiency in Microsoft Office Products (Outlook, Word, Excel).
• Knowledge of HIPAA and related Privacy and Security Acts.
• Team player with a passion for healthcare.

Education:

• High School Diploma or equivalent.

Responsibilities:

• Handle commercial payers, specifically 4 different BCBS plans.
• Manage a high volume of claims that are over 90 days past due.
• Handle both high and low dollar claims, averaging 45 claims a day.
• Follow up with providers to ensure timely payment of claims.
• Work on complex denials, adjustment requests, and appeals.
• Process both in-patient and out-patient claims using UB-04 and 1500 claim forms.
• Utilize Cerner EMR system.

Must Haves:

• Experience working on claims over 90 days past due.
• Knowledge of commercial claims (BCBS).
• Experience with both UB-04 and 1500s (in-patient and out-patient claims).
• Minimum of 2 years of experience in a similar role.

Nice to Have Skills:

• Bilingual (Spanish) is a huge plus.
• Experience with Cerner EMR.
• Rural health-specialty billing experience.
• Flexibility, adaptability, and reliability.
• Proactive and self-starter attitude.
• Good tenure in previous positions.

Attire:

• Business casual.

Selling Points:

• Opportunity to work with a growing organization.
• Supporting over 8 hospitals, with more additions planned this year.
• Collaborative team of 16 members, including 2 managers and a director.

Parking:

• Remote.

If you are a proactive, reliable individual with strong claims management experience and a passion for healthcare, we would love to hear from you.

Apply Now!