Insurance Follow-Up Specialist - Denials & Reimbursements

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

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.