Insurance Follow UP Specialist

Employment Type: Full-Time or Part-Time Available |Department: Medical Billing

Position Summary

Practice Management & Billing Solutions is seeking an experienced and detail-oriented Medical Insurance Follow-Up Specialist to join our growing billing team. In this role, you will be responsible for managing payer follow-up, resolving denials, and ensuring timely reimbursement for anesthesia and related medical services rendered at our partner facilities. The ideal candidate brings a strong command of medical billing processes, payer guidelines, and a proactive approach to accounts receivable management.

Key Responsibilities

• Conduct timely and persistent follow-up on all outstanding claims, including aging accounts receivable, to maximize collections and minimize denials.
• Review and resolve claim denials, rejections, and underpayments by identifying root causes and submitting appeals or corrected claims as appropriate.
• Verify patient insurance eligibility and benefits prior to and following dates of service.
• Communicate professionally with insurance carriers, providers, and patients to resolve billing issues and obtain necessary information.
• Monitor and work payer-specific work queues, ensuring claims are processed within payer timely filing deadlines.
• Maintain up-to-date knowledge of billing and coding guidelines for anesthesia services, including ASA units, base units, and time units.
• Ensure compliance with HIPAA regulations and all applicable state and federal billing regulations.
• Collaborate with clinical and administrative staff to resolve documentation deficiencies that impact billing.
• Generate and analyze reports on claim status, denial trends, and collection metrics; communicate findings to management.
• Participate in payer credentialing updates and fee schedule reviews as needed.
• Perform other billing-related duties as assigned by the Billing Office Manager.

Preferred Qualifications

Education

• High School Diploma or GED required.
• Associate’s or Bachelor’s degree in Health Information Management, Business Administration, or a related field preferred.

Certifications

• Anesthesia-specific billing certification or training is highly desirable.

Experience

• Minimum of 2–3 years of hands‑on medical billing and insurance follow‑up experience in a healthcare or billing office setting.
• Experience with anesthesia billing strongly preferred, including knowledge of ASA relative value units, base units, time units, and anesthesia-specific modifiers.
• Working knowledge of Medicare, Medicaid, and commercial insurance billing requirements.
• Demonstrated experience working claim denials, appeals, and accounts receivable follow‑up.

Knowledge & Skills

• Proficiency in medical billing software and practice management systems (e.g., PhyGene, Epic, Medent, or similar platforms).
• Strong understanding of ASA, CPT, ICD-10, and HCPCS coding as they relate to billing and claim submission.
• Thorough knowledge of the claims lifecycle, including electronic claim submission (837P), ERA/EOB reconciliation (835), and clearinghouse workflows.
• Solid understanding of payer contract terms, allowed amounts, and coordination of benefits (COB).
• Proficiency with Microsoft Office Suite, particularly Excel and Word.
• Excellent written and verbal communication skills.
• Strong analytical and problem‑solving skills with high attention to detail.
• Ability to prioritize and manage a high‑volume workload while meeting deadlines.
• Self‑motivated with the ability to work independently as well as collaboratively in a team environment.
• Strict adherence to patient confidentiality and HIPAA compliance at all times.
• Full-Time or Part-Time position; standard business hours, Monday through Friday.
• Office-based or hybrid/remote work arrangements may be available depending on experience and demonstrated performance.
• Must have a reliable internet connection and a dedicated, HIPAA‑compliant workspace if working remotely.
• Occasional overtime may be required during peak billing periods or month‑end close.
• Competitive salary commensurate with experience.
• Health, dental, and vision insurance.
• Paid time off (PTO) and paid holidays.
• 401(k) retirement plan with profit sharing.
• Supportive team environment with opportunities for advancement.

Equal Opportunity Employer

We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law. We are committed to creating an inclusive environment for all employees.