Virtual Insurance Professional

JOB SUMMARY: FMS, Inc. is seeking a proactive and detail-oriented Medical Insurance Follow-Up Agent to join our Revenue Cycle team. In this role, you will be responsible for ensuring timely and accurate follow-up on medical insurance claims. Your primary goal is to identify and resolve issues that prevent reimbursement, while maintaining compliance with all payer and regulatory guidelines.

JOB DUTIES AND RESPONSIBILITIES:

Conduct timely follow-up on outstanding insurance claims via phone, online portals, or written correspondence.
Investigate and resolve denied, delayed, or underpaid claims by communicating with insurance companies and third-party payers.
Review Explanation of Benefits (EOBs) and remittance advice to ensure proper claim adjudication.
Identify trends in denials or payment delays and escalate issues as necessary.
Document all claim activity and communications accurately in the billing system.
Verify insurance coverage and eligibility when required for follow-up activities.
Collaborate with billing, coding, and patient services teams to resolve discrepancies.
Maintain compliance with HIPAA and other applicable laws and guidelines related to medical billing and patient privacy.
Meet department productivity and quality standards.

JOB QUALIFICATIONS:

Education:
High school diploma or equivalent required.
Associate degree or coursework in healthcare administration, billing, or a related field preferred.
~ Experience:

• 1+ year of experience in medical billing, insurance follow-up, or healthcare collections required.
• Familiarity with commercial, Medicare, and Medicaid insurance plans strongly preferred.

Skills & Competencies:
Strong knowledge of EOBs, claim denials, appeals, and reimbursement processes.
Excellent verbal and written communication skills.
Strong organizational and time management skills.
Proficiency in medical billing software and Microsoft Office (Excel, Outlook, Word).
Ability to work independently and as part of a team.
High attention to detail and accuracy.
Proficient typist with ability to operate and navigate multiple computer systems with ease.

WORK-FROM-HOME REQUIREMENTS:

Reliable high-speed internet and secure, quiet workspace Employee-provided WFH equipment Desktop & Dual Monitors - 4vCPU with minimum 1.6 GHz or faster processor. For higher video/screen share resolution and frame rate, a four-core processor or better is required

RAM: 8000 MB

Hard Drive: 6 GB or more .NET Framework version 4.6.1 or later Windows 10/11 Mouse Headset Webcam

Comfortable using video conferencing tools throughout each scheduled shift
Ability to maintain confidentiality and protect patient health information (PHI) in a remote environment