Insurance Follow Up Rep

Mountain Management Services; United States; Sur place; USD 35 000 - 55 000; Plein temps

Résumé du poste

CommonSpirit Medical Group (Mountain Management Services) is hiring an Insurance Follow Up Representative to resolve unpaid insurance claims and collect outstanding balances from third-party payers. You will review denials, initiate follow-up with insurers, rectify billing errors, and negotiate for maximum reimbursement to optimize revenue recovery.

You will use a solid understanding of billing regulations, strong problem-solving abilities, and clear communication to explain balances and

Qualifications

• Understanding of billing regulations and reimbursements
• Strong problem-solving and analytical skills
• Effective written and verbal communication with payers
• Ability to review denials and appeals
• Experience with EOBs and remittance advice

Responsabilités

• Follows-up with insurance payers to research and resolve unpaid accounts receivable; applies corrections in the practice management system for FMG providers.
• Interprets Explanation of Benefits (EOBs) and remittance advice to ensure correct payments.
• Communicates with payers by phone and in writing to explain balances and rationale for denials/underpayments.
• Resubmits claims with required information as requested.
• Identifies trends and areas for improvement in the follow-up process and supports staff training.
• Escalates complex balances through defined channels when extra assistance is needed.

Formation

High School Graduate

High School GED

Post-high school program in medical billing or business field

Two years revenue cycle experience

Description du poste

Where You’ll Work

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Job Summary and Responsibilities

As an Insurance Follow Up Rep, you will resolve unpaid insurance claims and collect outstanding balances from third-party payers.Every day you will review denials, initiate follow-up with insurers, rectify billing errors, submit appeals, and negotiate for maximum reimbursement. To be successful, you will understand billing regulations, possess strong problem-solving skills, and communicate effectively to optimize revenue recovery.

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is received for all FMG providers.


• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.


• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.


• Resubmits claims with necessary information when requested through paper or electronic methods.


• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.


• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

Job Requirements

Required

• High School Graduate, upon hire or


• High School GED, upon hire

Preferred

• Other Graduation from a post-high school program in medical billing or other business-related field and Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities. , upon hire