Insurance Claims & Denials Specialist

Southeast Orthopedic Specialists, LLC; Jacksonville (FL); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Monthly stipend for ancillary benefits

HSA with HDHP plans with company match

401k plan

Employee Assistance Program 24/7

Employee Appreciation Days/Events

Paid Holidays & Paid Time Off

Job summary

Southeast Orthopedic Specialists is seeking an Insurance Follow Representative to manage payer communications, review denials, and drive timely reimbursements. You will verify claims, appeal when needed, and reduce outstanding accounts receivable while coordinating with clinical teams.

Experience with BCBS and other insurers, strong Excel/Word skills, and the ability to read Explanation of Benefits are essential. This role offers benefits including 401k, HSA, PTO, and more.

Qualifications

• Minimum of two years of medical claims processing experience.
• Able to read and understand Explanation of Benefits and denial reasons.
• Advanced computer knowledge, including Windows-based programs such as Word and Excel.
• Experience working with Blue Cross/Blue Shield, Commercial insurance companies, and Workman's Compensation carriers.

Responsibilities

• Review insurance denials to determine next steps to receive payment from the payor.
• Appeal claims that have been denied for no auth, medical necessity, etc.
• Verify receipt of claims with insurance plans to ensure timely reimbursement.
• Assume full responsibility for reducing accounts receivable of insurance balances.
• Communicate with payors through phone calls, emails, and payor portals.
• Process and take action on any written correspondence from insurance payors.
• Identify and trend reasons for claim denials.
• Resolve claim discrepancies reported by patients and other clinical departments.

Skills

Claims processing

EOB interpretation

MS Word & Excel

BCBS experience

Workman's Comp knowledge

Tools

Blue Cross/Blue Shield systems

Claim portals

Job description

Southeast Orthopedic Specialists is seeking an Insurance Follow Representative to manage payer communications, review denials, and drive timely reimbursements. You will verify claims, appeal when needed, and reduce outstanding accounts receivable while coordinating with clinical teams.

Experience with BCBS and other insurers, strong Excel/Word skills, and the ability to read Explanation of Benefits are essential. This role offers benefits including 401k, HSA, PTO, and more.