Insurance Claim Follow-Up Representative

Job Description

Job Description

Required Skills & Experience

• High school diploma or equivalent

• Outpatient hospital billing experience

• 5+ years Experience with facility claims follow-up & appeals handling

- COB issues, coding issues, misinterpretation of contract issues, etc.)

• Strong experience working with BlueCross BlueShield CareFirst and/or BlueCard

• Experience meeting a productivity standard of following up on ~80 claims per day with 98% accuracy.

• Knowledgeable of ICD + CPT Codes

• Independent & Fast Learner

• Tech Savvy (Excel, Teams, etc.) and experience working fully remotely

Nice to Have Skills & Experience

• Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

Job Description

Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues—not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).