Insurance Follow-Up & Denial Resolution Specialist

Catholic Health Services; Melville (NY); On-site; USD 33,000 - 43,000; Full time

Job summary

Catholic Health is seeking an Insurance Follow-Up Representative to investigate claims status with insurance carriers, correct and resubmit denied claims in the EPIC billing system. This role supports our Long Island facilities by ensuring accurate patient billing and timely claim resolution.

Minimum of 3 years of physician billing experience and a High School diploma are required, along with strong knowledge of medical insurance, AR systems, and excellent verbal communication.

Qualifications

• High School diploma or equivalent required.
• Strong knowledge of medical insurance and healthcare billing.
• Establishes and demonstrates competency in accounts receivable systems and associated applications.
• Ability to communicate effectively with insurance carriers, patients, and co-workers.
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm.
• Excellent verbal and auditory skills are required for communicating with internal staff, customers and representatives from external departments and agencies.

Responsibilities

• Performs follow up on all outstanding accounts assigned in accordance with established standards and procedures.
• Determines reason for denial and appeals accounts as necessary.
• Reviews and edits any rejections stemming from electronic billing submissions and corrects and resubmits claims.
• Verifies accuracy of patient insurance and demographic information.
• Generates bills to patients for services not covered by insurance.
• Investigates over-payments and takes appropriate action to resolve. Initiates refund requests in accordance with departmental procedures.
• Responds to requests for information and telephone inquiries from patients, insurance carriers, and outside agencies in a courteous manner.
• Send secondary claims to appropriate payors.

Skills

Verbal communication

Customer service

Education

High School diploma or equivalent

Tools

EPIC Billing System

Job description

Catholic Health is seeking an Insurance Follow-Up Representative to investigate claims status with insurance carriers, correct and resubmit denied claims in the EPIC billing system. This role supports our Long Island facilities by ensuring accurate patient billing and timely claim resolution.

Minimum of 3 years of physician billing experience and a High School diploma are required, along with strong knowledge of medical insurance, AR systems, and excellent verbal communication.