Billing Representative

Claims Follow-Up Specialist

Position Summary:

We are seeking a detail-oriented Claims Follow-up Specialist to join our Revenue Cycle team. This position is responsible for reviewing and processing paper insurance correspondence, including claim denials, requests for medical records and payer appeals. The Claims Follow-Up Specialist plays a critical role in maximizing reimbursement by ensuring payer requests are handled accurately, timely and in accordance with company policies and payer requirements.

This is a full-time, Monday through Friday, in-office position. Candidates must be able to work on-site during regular business hours.

The ideal candidate possesses strong analytical skills, excellent attention to detail and the ability to interpret insurance correspondence while meeting strict filing deadlines.

Essential Duties and Responsibilities

• Review and process paper insurance denials received from commercial, Medicare, Medicaid and Managed Care Payers.
• Analyze denial reasons and route accounts for appropriate follow-up or correction when necessary.
• Prepare, assemble and submit medical records requested by insurance companies within required timeframes.
• Prepare and submit first-level and subsequent level appeals for denied or underpaid claims.
• Ensure appeals are submitted within payer filing limits and according to payer-specific requirements.
• Monitor outstanding requests and appeals to ensure timely resolution.
• Document all actions taken within the revenue cycle management system.
• Communicate with insurance companies to clarify denial reasons, appeal requirements and documentation requests.

Qualifications

• High school diploma or equivalent required.
• Previous medical billing, patient accounts, insurance follow-up, claims processing or revenue cycle experience preferred, but not required to apply.
• Knowledge of Medicare, Medicaid, Commercial Insurance and patient billing process preferred, but not required to apply.
• Strong organizational and time management skills.
• Excellent attention to detail and accuracy.
• Proficient computer skills is a must.
• Ability to maintain confidentiality and handle sensitive information professionally.
• Ability to prioritize multiple tasks in a fast-paced environment.

Physical Requirements

• Prolonged periods of sitting and computer use.
• Ability to communicate effectively by phone, email and in-person.

Why Join Our Team?

• Comprehensive benefits package
• Paid time off
• Opportunities for professional growth and advancement
• Collaborative and supportive work environment
• Opportunity to make a meaningful impact on the organization's revenue cycle operations