Claims Follow-Up Specialist

Reports to: Claims Supervisor

Employment Status: Full-Time

FLSA Status: Non-Exempt

Work Location: On-site - Fort Lauderdale, FL

Job Summary:

To ensure a timely and accurate collection of medical claims. The Claims 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 work on unpaid claims, identifying and rectifying billing issues.
• Communicate 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 the next steps for unpaid claims.
• Collaborate 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.
• Assist patients with inquiries related to their insurance claims, providing clear and accurate information.
• All other duties assigned by the department supervisor and/or management team.

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.

Benefits

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401(k) plan with matching contributions

CodeMax is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

CodeMax is a participating employer in the federal E-Verify program.