Insurance Follow-Up Representative

Healthcare Outcomes Performance Co. (HOPCo); Jacksonville (FL); On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

Monthly stipend toward ancillary benefi

HSA with company match

401k plan

Employee Assistance Program 24/7

Employee Appreciation Days/Events

Paid Holidays & Paid Time Off

Job summary

Southeast Orthopedic Specialists in Jacksonville, FL, is seeking Insurance Follow Up Representatives for our Central Business Office. The role focuses on pursuing insurance reimbursements by reviewing denials, appealing claims, and ensuring timely processing.

The ideal candidate has at least two years of medical claims experience, can interpret EOBs, and is proficient with Word and Excel. Knowledge of BCBS, commercial, and WC carriers is preferred.

Qualifications

• Must have a minimum of two years of medical claims processing experience.
• Must be able to read and understand the Explanation of Benefits and denial reasons.
• Advanced computer knowledge, including Word and Excel.
• Experience with Blue Cross/Blue Shield, Commercial insurance, and Workman's Compensation carriers.

Responsibilities

• Review insurance denials to determine next steps to obtain payment.
• Appeal denied claims for lack of authorization, medical necessity, etc.
• Verify receipt of claims with insurance plans to ensure timely reimbursement.
• Reduce accounts receivable for insurance balances by following up on outstanding items.
• Communicate with payors via phone, email, and payor portals.
• Process and act on written correspondence from insurance payors.
• Identify and trend reasons for claim denials.
• Resolve claim discrepancies reported by patients and clinical departments.

Skills

Medical claims processing

EOB interpretation

Excel proficiency

Insurance carrier experience

MS Word

Tools

MS Word

MS Excel

Job description

Established in 2001, Southeast Orthopedic Specialists is a regional leader in musculoskeletal medicine. We are dedicated to growing with our patients. Our reach will continue to expand to meet the needs of all patients, present and future. It is our wish to make industry-leading five-star orthopedic care accessible to as many people as possible.

As Southeast Orthopedic Specialists continues to grow, we are hiring Insurance Follow-Up Representatives for our Central Business Office located in Jacksonville, FL !Please see below for the functions and requirements for this position:

Insurance Follow Representatives are responsible for following patient accounts, through the insurance payors to ensure proper reimbursement to the practice.

In this role Insurance Follow Up Reps will:

• Review insurance denials to determine and take the next appropriate action 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 timeliness of claims reimbursement.
• Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts.
• Communicating 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.

The ideal candidate will have:

• Must have a minimum of two years of medical claims processing experience.
• Must be able to read and understand the 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.

At Southeast Orthopedic Specialists, we are dedicated to taking care of you so you can take care of business! Our robust BENEFITS PACKAGE includes the following:

• Monthly stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan
• Employee Assistance Program available 24/7
• Employee Appreciation Days/Events
• Paid Holidays & Paid Time Off
• AND MORE!

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.