Job Title: Medical Claim Follow-Up Specialist

Reports to: Claim Follow-Up Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Job Summary:

We are searching for a diligent Medical Claim Follow-Up Specialist to ensure the timely and accurate collection of medical claims. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims.

Duties/Responsibilities:

• Reviews and works on unpaid claims, identifying and rectifying billing issues.

• Communicates with insurance companies regarding any discrepancy in payments if necessary.

• Conducts research and appeals denied claims timely.

• Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons.

• Provides detailed notes on actions taken and next steps for unpaid claims.

• Collaborates with the billing team to ensure accurate claim submission.

• Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements.

• Resubmits claims with necessary corrections or supporting documentation when needed.

• Tracks and documents trends related to denials and work towards a resolution with the billing team.

• Assists patients with inquiries related to their insurance claims, providing clear and accurate information.

• All other duties as assigned.

Required Skills/Abilities:

• Proficiency in healthcare billing software.

• Strong analytical, organizational, and multitasking skills.

• Excellent verbal and written communication abilities.

• Ability to navigate payer websites and use online resources to resolve outstanding claims.

Education and Experience:

• High school diploma or equivalent required.

• Prior experience in medical billing collections or a similar role.

• Knowledge of medical terminology, CPT and ICD-10 coding is a plus.

• Knowledge of HIPAA and other healthcare industry regulations.