Insurance Claims Resolution Specialist

UT Health San Antonio; San Antonio (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

UT Health San Antonio is seeking an Insurance Follow-Up Specialist to manage unresolved claims and appeals, ensuring timely reimbursement across Medicare, Medicaid, Commercial, and Specialty payors. You will collaborate with Coding and Operations to resolve denials and verify patient benefits.

Ideal candidates have 3 years of hospital billing experience, strong attention to detail, and proficiency in Microsoft Office and EPIC. On-site role in San Antonio, TX.

Qualifications

• Three (3) years hospital business office or medical billing experience.
• Detail oriented with the ability to organize, prioritize and coordinate work within schedule constraints.
• Ability to multi-task in a fast paced, high-volume environment.
• Proficient in Microsoft Office.
• EPIC experience.

Responsibilities

• Initiates insurance follow up on unresolved appealed or unpaid claims, to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors.
• Submits appeals and reconsiderations on claim denials via practice management system, payor portals, or mail.
• Analyze daily claim rejections from our clearing house, screen claims for pre-authorization, request and submit medical records.
• Work closely with the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
• Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility or additional requests from payors
• Assist customer service team in resolving patient billing concerns or disputes.
• Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management team, and clinical departments.
• Completes all other duties as assigned.

Skills

Claims Reimbursement

Education

High school graduate or equivalent

Tools

Microsoft Office

EPIC

Job description

UT Health San Antonio is seeking an Insurance Follow-Up Specialist to manage unresolved claims and appeals, ensuring timely reimbursement across Medicare, Medicaid, Commercial, and Specialty payors. You will collaborate with Coding and Operations to resolve denials and verify patient benefits.

Ideal candidates have 3 years of hospital billing experience, strong attention to detail, and proficiency in Microsoft Office and EPIC. On-site role in San Antonio, TX.