Claims Follow-Up & Reimbursement Specialist

ECU Health; Greenville (NC); On-site; USD 42,000 - 68,000; Full time

Job summary

ECU Health in North Carolina is seeking an Insurance Follow-Up Specialist to manage third-party payer claims. You will submit claims electronically, reconcile reports, and address denials to secure timely payments.

Responsibilities include contacting payers, coordinating with billing teams, ensuring HIPAA compliance, and maintaining accurate documentation. The role requires strong attention to detail and excellent communication skills.

Qualifications

• High school diploma or equivalent required.
• 5+ years of experience in A/R follow-up.
• Certified Revenue Cycle Representative (CRCR) preferred.

Responsibilities

• Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.
• Identify and prioritize high-value or aged claims for immediate follow-up.
• Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.
• Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.
• Document all communication and actions taken on each claim in the billing system.
• Update patient accounts with the current status of claims and expected payment dates.
• Resubmit corrected claims to insurance companies when errors are identified.
• Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.
• Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.
• Assist patients with calling their insurance plans to resolve claim processing issues.
• Document detailed and organized follow-up activities, including communication logs, and claim statuses.
• Ensure that documentation is complete and compliant with internal policies and external regulations.
• Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.
• Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.
• Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.
• Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.
• Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.

Skills

Claims analysis

Attention to detail

Verbal & written communication

HIPAA compliance

Problem solving

Education

High school diploma or equivalent

Tools

Billing software

Hospital information systems

Coding methodologies

Job description

ECU Health in North Carolina is seeking an Insurance Follow-Up Specialist to manage third-party payer claims. You will submit claims electronically, reconcile reports, and address denials to secure timely payments.

Responsibilities include contacting payers, coordinating with billing teams, ensuring HIPAA compliance, and maintaining accurate documentation. The role requires strong attention to detail and excellent communication skills.