Insurance Follow-Up Specialist - Remote

Remote / Specialty Diagnostic Laboratory / Healthcare Revenue Cycle Management

Pay Rate: $28.85–$36.06 per hour
Employment Type: Temp Contract, Contract-to-Hire
Contract Length: 800 hours
Schedule: Monday–Friday, 8:00 AM–5:00 PM CST
Location: 100% remote
Education: High school diploma or equivalent required
Equipment: Provided by the client

Position Overview

We are seeking an Insurance Follow-Up Specialist to support a specialty diagnostic laboratory's revenue cycle management team. This role focuses on investigating and resolving outstanding insurance claims, administrative denials, and unresponsive appeals to help reduce a backlog of historical claims.

The ideal candidate has at least 5 years of medical billing experience, specifically in insurance claim follow-up, denial resolution, and claim processing. This individual should be persistent, analytical, and comfortable identifying patterns and resolving groups of similar claims efficiently rather than working each claim individually.

This is a fully remote, contract-to-hire opportunity with the potential to transition into a permanent position based on performance and business needs.

Key Responsibilities

• Investigate Outstanding Claims: Review claim details, denial codes, and explanations of benefits (EOBs) to identify the root causes of denials, including coding discrepancies, patient demographic errors, missing information, and administrative issues.

• Follow Up on Unresponsive Claims: Research claims submitted more than 60 days ago that have received no response, as well as previously submitted appeals with no decision or denial explanation.

• Contact Insurance Payers: Use payer portals and outbound phone calls to check claim statuses, obtain EOBs, clarify denial reasons, and determine why claims have not been processed.

• Resolve Claims in Batches: Group claims by payer or denial reason to identify common issues and efficiently resolve high volumes of similar claims through targeted investigations.

• Correct and Resubmit Claims: Update missing or inaccurate information and resubmit corrected claims within payer-specific timely filing and correction deadlines.

• Document Claim Activity: Maintain accurate records of claim investigations, payer communications, corrective actions, and follow-up efforts.

• Escalate Complex Issues: Identify claims requiring formal reconsideration or appeals and refer them to the appropriate Appeals and Denials team.

• Identify Trends and Improve Processes: Collaborate with internal departments and revenue cycle leadership to identify recurring denial patterns and recommend process improvements.

Required Qualifications

• High school diploma or equivalent.

• Minimum of 5 years of medical billing experience, specifically in insurance claim follow-up, denial resolution, and claim processing.

• Strong understanding of Medicare, Medicaid, commercial insurance plans, Managed Care Organizations (MCOs), and Medicare Advantage.

• Knowledge of payer-specific billing guidelines and timely filing requirements.

• Excellent analytical, investigative, and problem-solving skills.

• Strong verbal and written communication skills, including the ability to communicate with insurance payers and document findings accurately.

• Excellent organizational and time management skills, with the ability to prioritize high-volume work queues and meet productivity goals.

• Ability to work independently and adapt to a fast-paced, fully remote environment.

• Understanding of HIPAA requirements and appropriate handling of protected health information (PHI).

• Proficiency with healthcare billing systems, payer portals, and Microsoft Office Suite.

• Ability to identify trends and resolve claims efficiently through batch investigations.

Preferred Qualifications

• Experience with molecular laboratory billing, genetic testing, or specialty diagnostic laboratory claims.

• Familiarity with complex clinical criteria and specialized healthcare requirements.

• Background in genetic counseling or another clinical field combined with revenue cycle management experience.

• Bachelor's degree or higher.

• Experience interpreting claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), explanations of benefits (EOBs), and CPT/ICD-10 codes.

Additional Details

• 100% remote position with equipment provided.

• Focused on resolving a backlog of outstanding claims and unresponsive appeals.

• Emphasis on claim investigation, administrative resolution, and problem-solving rather than completing formal appeals.

• One-round interview process lasting approximately 30 minutes.

• Potential to convert to a permanent, full-time position based on performance and business needs.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.