Insurance follow up specialist

**EXPERIENCE REQUIRED**

**PART TIME, Monday-Thursday 8:00-4:30**

Claims Follow-Up:

Review and analyze denied, rejected, or unpaid insurance claims.
Contact insurance companies to obtain information on claim status, reasons for denials, and necessary documentation.
Identify and rectify issues that led to claim denials, such as missing information, coding errors, or eligibility discrepancies.
Escalate complex or unresolved issues to the appropriate department or supervisor.

Billing and Documentation:

Verify accuracy of patient demographic and insurance information on claims.
Update and correct claim forms, ensuring adherence to insurance guidelines and regulations.
Collaborate with billing and coding teams to ensure accurate submission of claims.

Communication:

Communicate professionally and effectively with insurance company representatives, healthcare providers, and patients.
Maintain a respectful and empathetic demeanor while addressing inquiries and resolving issues.
Provide clear and concise explanations to patients regarding insurance coverage, benefits, and payment responsibilities.

Problem Solving:

Investigate and resolve claim discrepancies by coordinating with internal teams and external parties.
Analyze trends in denied claims to identify recurring issues and propose process improvements.

Appeals and Resubmissions:

Prepare and submit appeals for denied claims, providing necessary documentation and evidence to support the appeal process.
Monitor and track progress of appeals to ensure timely resolution.
Make recommendations for resubmitting corrected claims when necessary.

Documentation and Reporting:

Maintain accurate and organized records of all communications, actions taken, and claim status updates.
Generate reports and summaries related to claim status, denial trends, and resolution outcomes.

Compliance and Regulations:

Stay up-to-date with insurance regulations, coding guidelines, and industry changes that may impact claim processing.
Ensure compliance with all relevant healthcare and insurance regulations, including HIPAA.

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