Level 2 - Insurance Claim Follow-Up Representative

Outpatient Facility Claim Follow Up Representative

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 issuesnot 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.).

Primary Responsibilities:

• Claims Management: Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid. Determine what was paid, what was denied, and why. Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc.
• Payer Interaction: Handle all outpatient claims for Blue Cross Blue Shield CareFirst and/or BlueCard. Understand and navigate multiple contracts. Utilize BCBS portal to follow up and resolve outstanding claim issues.
• Analytical Review: Differentiate between pricing errors vs. payment errors. Accurately price claims based on contract terms and identify variances.

Scope of Work: Outpatient facility claims ONLY Technical denials ONLY