Insurance A/R Follow-Up Specialist

Description

An Insurance/AR Follow-Up Specialist plays a critical role in ensuring the financial health of the healthcare facility by managing the insurance claims process and following up on outstanding accounts receivable. Responsibilities include identifying and resolving claim denials, appealing underpaid or rejected claims, and communicating effectively with insurance companies and patients to facilitate timely reimbursement. The specialist utilizes their expertise in insurance billing procedures, coding, and reimbursement regulations to optimize revenue cycle management and minimize revenue loss. Attention to detail, persistence in claim resolution, and a strong understanding of healthcare reimbursement practices are essential for success in this role.

Responsibilities include, but are not limited to:

• Proficient in electronic medical records (EMR).
• Charge posting of services in a timely manner.
• Submit clean claims electronically to carriers.
• Review and maintain clearinghouse reports.
• Verify eligibility and benefit coverage.
• Investigate and review insurance denials and update accounts.
• Prepare and submit secondary claims as needed.
• Resolve questions related to deductible, co-insurance and co-pays.
• Prepare and submit appeal letters to insurance carriers.
• Recommend coding changes as required.
• Perform soft collections as needed.
• Scrub Aged Trial Balance Reports for insurance discoveries.
• Train required team members as needed.
• Review Denial Reports, update accounts and resolve the denial
• Generate bad debt submission reports and PFC Medicaid eligible reports.
• Assist with internal auditing initiatives.
• Perform other duties assigned by the management team.

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Paid training
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday-Friday 8:00 am - 4:30 pm
• 40 hours/week

Requirements

Skills:

• Accuracy in billing is crucial to avoid errors and ensure proper reimbursement.
• Ability to work independently.
• Proficiency in medical billing software (e.g., Kareo, AdvancedMD) and electronic health records (EHR) systems preferred.
• Understanding of medical terms, anatomy, and healthcare procedures.
• Effective verbal and written communication skills for interacting with colleagues, patients, and insurance companies.
• Ability to resolve billing discrepancies and manage claim denials.
• Efficient in managing multiple tasks and meeting deadlines.
• At least two years of experience in AR, medical billing or a related industry.

Education:

• 3-5 years of experience is required.
• A minimum requirement, though postsecondary education, High School Diploma/GED, is required.
• An associate’s degree in medical billing, health information management, or a related field can be advantageous.
• Certification as a Certified Professional Biller (CPB) or Certified Coding Specialist (CCS) is preferred. Relevant certifications can be obtained from organizations like the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
• Ongoing education to stay current with changes in billing codes and regulations.
• Understanding of the local healthcare landscape, including major insurers and healthcare providers is preferred.