Insurance Claim Follow-Up Representative

Insight Global; Maryland; Teletrabalho; USD 60 000 - 85 000; Tempo integral

Resumo da oferta

Insight Global is seeking an Insurance Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. Primary focus is on outpatient BCBS claims, resolving underpayments, denials, and contract interpretation issues.

You will review EOBs, identify discrepancies, and take corrective actions with payers, working fully remotely. The role requires handling outpatient claims, using BCBS portals, and ensuring accuracy in pricing per contract terms.

Qualificações

• 5+ years experience in claims follow-up & appeals handling.
• Experience with UB04 forms and understanding payer denial mechanisms.
• Experience interacting with BCBS CareFirst and/or BlueCard.
• Familiarity with payer portals and contract interpretation.
• Ability to process ~80 claims per day with high accuracy (98%).
• Knowledge of ICD and CPT codes and their application in billing.
• Strong attention to detail to spot errors in claims/contracts.
• Analytical thinking to identify pricing variances and under/overpayments.
• Proficient in Excel and collaboration tools; remote work experience.

Responsabilidades

• Take ownership of outpatient hospital claims after billing, especially denied or underpaid ones.
• Determine payments, denials, and reasons for action.
• Identify and resolve technical denials related to coding, COBs, and contract interpretation.
• Handle outpatient claims for BCBS CareFirst and/or BlueCard; navigate contracts.
• Use payer portals to follow up and resolve issues; communicate with payers.
• Accurately price claims based on contract terms and identify variances.

Conhecimentos

Claims follow-up

UB04 forms

BCBS CareFirst

Payer portal

80 claims/day

ICD/CPT codes

Attention to detail

Analytical thinking

Excel

Teams

Ferramentas

Med-Connect

RCI

Envision (SMS)

Epic

Descrição da oferta de emprego

• 5+ years Experience with claims follow-up & appeals handling
  • Experience with UB04 forms
  • This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.)
• Strong experience working with BlueCross BlueShield CareFirst and/or BlueCard
  • Familiarity using payer portal, their escalation process, how to read and interpret contracts
• Experience meeting a productivity standard of following up on ~80 claims per day with 98% accuracy.
• Knowledgeable of ICD + CPT Codes
• Attention to Detail:
  • Must be able to spot errors and inconsistencies in claims and contracts.
• Analytical Thinking:
  • Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly.
• Tech Savvy (Excel, Teams, etc.) and experience working fully remotely

Nice to Have Skills & Experience

• Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

Job Description

Insight Global is looking for an Insurance Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues—not clinical denials or patient balances. The representative ensures acr managing post-billing,curate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).

Primary Responsibilities

Claims Management

• Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid.
• Determine what was paid, what was denied, and why.
• Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc.

Payer Interaction

• Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard.
• Understand and navigate multiple contracts.
• Utilize BCBS portal to follow up and resolve outstanding claim issues.

Analytical Review

• Accurately price claims based on contract terms and identify variances.