Medical Claim Follow Up Specialist, Remote

Centauri Health Solutions; Idaho; Remote; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a Medical Claim Follow Up Specialist to join their remote team. In this pivotal role, you will manage and resolve Out of State Medicaid claims, ensuring efficient communication with payers and meticulous documentation of claim statuses. Your analytical skills will be essential as you navigate complex insurance processes and collaborate with team members to enhance patient outcomes. This position offers an opportunity to make a significant impact in healthcare, working alongside dedicated professionals in a supportive environment. If you thrive in a fast-paced setting and are passionate about improving healthcare services, this role is perfect for you.

Qualifications

• 1-2 years of collection or follow-up experience is strongly recommended.
• Knowledge of state policies/procedures on determining eligibility and claims processing.

Responsibilities

• Resolve billed claims and manage assigned work queues.
• Document claim status and communicate payer trends to Team Leader.
• Identify denied line items and take necessary steps to resolve accounts.

Skills

EOB and RA Review

Insurance Knowledge

Payer Portal Navigation

Insurance Payment Methodologies

Denial Resolution Processing

Microsoft Office

Attention to Detail

Self-starter

Organizational Skills

Analytical Thinking

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Medical Claim Follow Up Specialist, Remote

Idaho, USA Req #3251

Tuesday, March 11, 2025

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500 list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com.

Role Summary:

The OOS Team works with facilities across the US to process their Out of State Medicaid claims. We focus on hospital billing and follow up, hospital and physician enrollment, as well as eligibility verifications. The Payment Recovery Specialist follows up on claim status, reviews payer responses, and assists with denial management. The Payment Recovery Specialist coordinates with departments and insurance companies to ensure follow-up on all appeals, claim payments, and denials, bringing claims to resolution. Their efforts help dictate the workflow of accounts to other team members as needed for account resolution. Team members will work with other members of the Out of State Medicaid Division to interpret eligibility, discern remittance advance and determine next steps for the life of the claim (payment posting, appeal, corrections, etc.).

Role Responsibilities:

• Resolves billed claims and referred denials
• Manage assigned work queues
• Performs contact with payers via phone calls and payer portals
• Documents related claim status activity
• Communicates pertinent payer trends to the Team Leader
• Upload copies of claim status and remits as needed
• Accountable for meeting established productivity measures and goals
• Prioritize workload based on follow up date, dollar amount, hospital request, aging, etc.
• Identify Medicaid Payor trends and issues and communicate to Team Lead/Service Line Manager
• Identify denied line items and take necessary steps with the payor to resolve the account
• Document findings and status within the system, using established department noting guidelines
• Follow up on accounts in a timely manner consistent with established team procedures
• Work together within assigned groups to determine next steps on the life of claim

Role Requirements:

• Knowledge of and experience reviewing Explanation of Benefits (EOB) and Remittance Advice (RA)
• Strong knowledge of insurance types, associated administrative guidelines, and terminology
• Strong knowledge of payer portal navigation
• Understanding of insurance payment methodologies
• Basic understanding of appeals/denial resolution processing needs
• Microsoft Office
• Attention to detail when noting systems and accounts
• Self-starter who can act when the need arises and use time efficiently when on hold with payors
• Ability to work independently but also collaborate with a team as needed
• Ability to manage and organize tasks for maximum efficiency
• Skill to navigate multiple systems within dual monitors
• Comfortable with being on the phone for several hours of the day
• Detail-oriented and analytical thinker
• Fast learner who can pick up new concepts and detailed procedures
• Ability to thrive in a high demand environment
• Knowledge of state policies/procedures on determining eligibility and claims processing
• Some knowledge of and experience with billing process and procedures
• Some knowledge of and experience with hospital patient billing systems; language, flow of work, processes, and procedures
• High School Diploma or GED equivalent
• Familiarity with UB04 and/or 1500 claims
• 1-2 years of collection or follow-up experience is strongly recommended.
• 6 months to one year of administrative or customer service experience.