Insurance Follow-up Representative II

Monday - Friday

8-5PM

Remote

The Insurance Follow-Up Representative II  is responsible for resolving outstanding insurance claims, with a strong focus on denied, delayed, or underpaid claims. This role requires advanced knowledge of payer guidelines, reimbursement processes, and effective communication with insurance companies to ensure timely payment.

Key Responsibilities

• Investigate and follow up on unpaid, denied, or underpaid insurance claims
• Analyze denial reasons and take appropriate corrective actions to ensure reimbursement
• Contact insurance payers via phone, chat, or web portals to obtain claim status and resolve issues
• Work assigned accounts from designated work queues, prioritizing high-value and aging claims
• Review claims for accuracy, including coding, billing data, and documentation compliance
• Submit corrected claims, appeals, or additional documentation as needed
• Utilize systems such as Availity to check claim status, eligibility, and submit inquiries
• Maintain detailed and accurate account notes for all follow-up activities
• Identify trends in denials and escalate recurring issues to management
• Meet productivity and quality benchmarks set by the organization

Qualifications

• Education:  High School Diploma or GED, required.
• Experience:  Minimum one year of (medical) insurance follow up experience, required.
• Additional Skills/Requirements (required):
• Good verbal and written communication skills. Experience operating computers/laptop. Clear and pleasant speaking voice on the telephone, hearing acuity that allows for understanding over the telephone, prolonged sitting, visual abilities and manual dexterity that allows the use of PCs for extended periods of time. Ability to operate 10 key keyboard. Ability to drive/travel to multiple locations/facilities as needed. Ability to work from home as needed.
• Additional Skills/Requirements (preferred):
• Basic accounting and medical terminology.