Represent our values: Awesome, Creative, Respectful, Team Players, Get it Done.
Work unpaid and partially paid insurance claims to resolve outstanding balances and secure accurate reimbursement in accordance with payer guidelines.
Research claim status by utilizing insurance portals, conducting phone outreach, and drafting written correspondence as needed.
Analyze denied or underpaid claims to identify root causes, trends, and necessary corrective actions.
Submit timely and well-documented appeals for denied claims in alignment with specific payer policies and appeal procedures.
Resubmit corrected claims with updated coding, documentation, or demographic information to facilitate proper adjudication.
Maintain thorough and accurate records of all claim follow-up activities within the billing or revenue cycle management system.
Collaborate with coding teams, clinical documentation specialists, and provider offices to gather missing information or resolve claim discrepancies.
Monitor aging accounts and prioritize claims based on timely filing limits and payer response windows.
Identify systemic issues or process inefficiencies impacting claim resolution and escalate concerns to management with supporting documentation.
Meet or exceed established productivity and quality benchmarks while adhering to compliance and privacy standards.
Other duties as assigned.

High school diploma or equivalent required; associate’s degree in healthcare administration, Business, or a related field preferred.
2+ years of experience in medical billing, with a focus on professional billing and accounts receivable follow-up.
Solid understanding of CPT, HCPCS, and ICD-10 coding systems and their application in claim submission and reimbursement.
Experience working with electronic billing systems and payer portals to manage claim status, denials, and appeals.
Familiarity with insurance reimbursement methodologies, claim adjudication processes, and payer-specific requirements.
Working knowledge of medical terminology and healthcare documentation.
Strong analytical and problem-solving skills with the ability to identify issues, evaluate alternatives, and implement solutions.
Excellent written and verbal communication skills, with the ability to collaborate effectively across teams and with external contacts.
High attention to detail and accuracy, with proven ability to manage multiple tasks and meet deadlines in a fast-paced environment.

Billing Specialist – Insurance Follow-up

Key skills