Insurance Follow-Up Specialist

OUR COMPANY:

The accounts receivables industry plays an essential role in the local and national economy. Revco-Wakefield provides best-in-class Revenue Cycle management to Hospital and Physician Service clients.

Position Description:

The Medical Insurance Follow-Up Specialist is responsible for ensuring the timely and accurate resolution of outstanding insurance claims. This role involves investigating and resolving unpaid or underpaid claims by communicating with insurance carriers, identifying billing issues, and initiating corrective actions. The specialist plays a critical role in maximizing reimbursement and supporting the overall revenue cycle by maintaining detailed documentation and adhering to regulatory and payer-specific guidelines.

Duties & Responsibilities:

• Conduct detailed analysis and follow-up on outstanding insurance claims (both commercial and government), ensuring timely and accurate resolution in accordance with payer guidelines.
• Research and resolve claim denials, rejections, and underpayments by initiating appropriate billing corrections, appeals, and resubmissions.
• Prepare and submit claim documentation—including EOBs, itemized statements, and medical records—as required by payers to support claim adjudication.
• Respond to payer and patient inquiries related to delinquent claims, maintaining compliance with privacy regulations and payer contract guidelines.
• Utilize payer portals, Electronic Health Records (EHR), and patient accounting systems to investigate claim status, post notes, and manage follow-up activities.
• Identify trends in denials and payment delays, contributing to process improvement initiatives and strategies for reducing AR days.
• Maintain accurate and detailed records of account activity, ensuring that production goals and quality standards are consistently met or exceeded.
• Demonstrate strong communication skills when interacting with insurance representatives, patients (as appropriate), and internal departments to resolve outstanding issues.
• Prioritize and organize daily workload effectively to meet departmental benchmarks in a fast-paced, high-volume environment.
• Provide support on special projects and additional assignments as requested by management

Requirements:

• 2 years of previous experience working with commercial or other third-party insurance claims, medical billing/follow-up, BCBS experience is a plus
• An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice
• EPIC experience preferred but not required
• Certificates, Licenses, Registrations, and/or Medicare certification are a plus, but not required

REVCO OFFERS:

• Medical, Dental, Vision, Life and Disability coverage
• 401(k) Savings Plan with company match
• Paid Time Off (PTO), Paid Holidays, and Paid Training

HOURS: 8:00am-5:00pm CST/9:00am-6:00pm EST

Job Type: Full-time

Pay: $ $21.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Application Question(s):

• How many years of Epic experience do you have?
• Explain how you handle a denied or underpaid claim.
• What systems and/or programs do you have experience with?
• Do you live in CO, FL, GA, IA, IN, MI, NE, NC, NJ, NY, OH, PA, SC, TN, TX, VA?

• Explain your understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice.

• Explain your experience working with commercial and other third-party insurance claims, medical billing/follow-up and BCBS.

Work Location: Remote