Claims Specialist

Job Summary:

The Claims Follow-Up Specialist is responsible for monitoring and following up on outstanding insurance claims to ensure timely reimbursement and resolution. This role plays a key part in the revenue cycle process by reducing accounts receivable and increasing cash flow. The specialist investigates claim denials, communicates with insurance companies, and ensures that all claims are processed accurately and in compliance with payer requirements.

Key Responsibilities:

• Review aging reports and identify outstanding or denied claims requiring follow-up.
• Contact insurance companies via phone, portal, or email to check claim status and resolve issues.
• Research and resolve claim denials, rejections, and underpayments.
• Appeal denied claims when necessary, ensuring compliance with insurance guidelines and deadlines.
• Document all activities and communications related to claim follow-up in the billing system.
• Collaborate with other departments such as coding, front desk, and patient services to gather required documentation and correct errors.
• Maintain up-to-date knowledge of insurance payer rules and regulatory changes.
• Monitor claim processing timelines to ensure prompt submission and follow-up.
• Meet or exceed productivity and quality performance metrics.
• Assist with special projects or audits related to accounts receivable as assigned.

Qualifications:

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 1–2 years of experience in medical billing, claims follow-up, or healthcare revenue cycle.
• Strong knowledge of medical billing practices, insurance guidelines (Medicare, Medicaid, commercial payers), and CPT/ICD-10 coding basics.
• Proficiency in using practice management software and payer portals.
• Excellent communication skills, both verbal and written.
• Strong analytical and problem-solving abilities.
• Ability to work independently, prioritize tasks, and manage time effectively.
• Detail-oriented with a high degree of accuracy and professionalism.

Preferred Skills:

• Experience with electronic health record (EHR) systems such as Epic, Cerner, AdvancedMD, or similar.
• Familiarity with HIPAA compliance and medical terminology.

Salary : $18 - $22