Insurance Follow-Up Representative Medicare Managed Care

Insurance Follow-Up Representative Medicare Managed Care

Addison Group is partnering with a healthcare organization seeking an experienced Insurance Follow-Up Representative to support physician billing and collections. This role focuses on resolving Medicare Managed Care claims and is ideal for candidates with strong payer follow-up and denial resolution experience.

The Insurance Follow-Up / Denials Representative will manage assigned accounts within a revenue cycle team, working to resolve denials, rejections, and outstanding claims. This position requires strong knowledge of professional billing workflows, payer guidelines, and the ability to work efficiently within a high-volume environment.

After an initial onsite training period, this role transitions to a hybrid schedule.

Key Responsibilities:

• Follow up on physician claims and resolve denials, rejections, and unpaid balances.
• Work within EMR work queues to manage assigned accounts.
• Communicate with Medicare Managed Care payers to obtain claim status and resolve issues.
• Submit corrected claims, reconsiderations, and appeals as needed.
• Analyze EOBs and payer responses to determine appropriate next steps.
• Identify and resolve billing and registration-related denials.
• Maintain detailed and accurate documentation of all account activity.
• Work accounts through full resolution from initial denial to payment.
• Meet productivity and quality benchmarks.

Requirements:

• Recent (3-4 years) physician insurance follow-up experience required (CMS-1500 claims).
• Strong experience with denials, appeals, corrected claims, and rejections.
• Experience with Medicare Managed Care (MCO) payers required (STAR, STAR+, CHIP, etc.).
• Familiarity with major payers such as Molina, UHC, Aetna, and similar plans preferred.
• Experience with Epic or similar EMR systems required.
• Strong understanding of payer guidelines and claim resolution processes.
• Ability to work independently and manage high-volume workloads.
• Strong communication and documentation skills.

Additional Details:

• Schedule: MondayFriday, 8-hour shift (start as early as 7:00 AM)
• Work Model: Hybrid (remote most days with periodic onsite requirements after training)
• Training: Approximately 14 weeks onsite
• Assignment Type: Contract-to-Hire
• Environment: Business office revenue cycle team
• Start Date: ASAP

Perks:

• Hybrid work flexibility after onboarding
• Opportunity to gain experience in a large healthcare system environment
• Strong team support and structured workflows
• Career growth potential within revenue cycle operations

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.