Overview
This role supports the operations of the Revenue Cycle Management (RCM) team focused on follow-up and resolution of outstanding insurance claims. Reporting to the Accounts Receivable Supervisor, the position involves investigating and resolving claims submitted to insurance for payment and documenting detailed notes on claim status.
Responsibilities
- Contact insurance carriers daily to follow up on and collect past due amounts on outstanding medical claims related to denials or benefit changes.
- Maintain an accurate and up-to-date aging of assigned accounts, including accounts receivable analysis and follow-up.
- Stay informed on billing and medical policies for all payers.
- Understand in-network and out-of-network reimbursement processes and methodologies.
- Create and follow up on appeals to contest denials or incorrect payments.
- Review and resolve complex denials and tasks assigned by the payment posting team, including refund requests, disputes, and appeals.
- Collaborate across all RCM departments to resolve issues related to claims payment.
- Ensure compliance with all company policies, procedures, and regulatory requirements.
- Work with the Accounts Receivable Supervisor to review and resolve open accounts as assigned.
- Perform other duties as assigned.
Requirements
Education
- High School Diploma or GED
Experience
- Minimum 3 years managing Accounts Receivable and performing direct follow-up with payers.
- At least 1 year of effective oral and written communication experience with insurance payers and internal teams.
- 3 years working knowledge of medical terminology, ICD-10, CPT, HCPCS coding, and HIPAA requirements.
- 2 years experience with data processing and analytical skills, proficiency in Excel, Microsoft Office Suite, medical practice management software, and electronic medical records.
- 3 years experience working with commercial, government, and state insurance payers and their reimbursement policies and procedures.
- 3 years experience handling complex insurance issues, including correct payer assignment, EOB adjustments, and refunds.
Skills and Abilities
- Strong relationship-building skills and commitment to excellent customer service.
- Proficient in computer use for data entry, research, and information retrieval.
- High attention to detail, accuracy, and ability to multitask.
- Highly developed problem-solving skills.
- Professionalism and kindness when interacting with staff, payers, patients, and families.
- Ability to ensure services comply with state and federal regulations, organizational policies, and accreditation requirements.
- Ethical behavior and role modeling aligned with organizational values.
- Ability to promptly identify and report issues.
- Reliable attendance and ability to manage high volumes of work independently.
- Effective monitoring of claims processing steps.
Preferred Qualifications
- 1 year experience with Federally Qualified Health Center (FQHC) billing and revenue cycle activities.
- 1 year experience with EPIC Practice Management/Electronic Medical Records (PM/EMR) system.
Location
Position location details to be provided by the employer.
Compensation & Benefits
Compensation and benefits information to be provided by the employer.