Remote Insurance Follow-Up Specialist: Denials & Appeals

Optum; Las Vegas (NV); Remote; USD 25,000 - 44,000; Full time

Benefits offered by this job

Benefits package

Job summary

Optum is hiring an Insurance Follow Up Representative for a full-time remote role serving the Pacific and Mountain Time zones. The position focuses on obtaining timely payments, resolving denials, and writing appeals while adhering to payer guidelines and CMS 1500 processes.

The candidate should have 2+ years in insurance follow up, CPT/Diagnosis coding knowledge, and familiarity with EOB/REMITS. Flexible shifts during 7:00 am–3:30 pm PST, with occasional overtime.

Qualifications

• 2+ years of experience in insurance follow up and denial management.
• Experience in appeals writing and processing.
• Knowledge of EOB, COB, Remits, and CMS 1500.
• Understanding CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy.

Responsibilities

• Contacts insurance carriers / patients to obtain proper payment based on EOB/Experian modeling expectations.
• Identify denial root causes using clinic policies.
• Prepares documentation for insurance appeals.
• Processes the appealing of claims reimbursed incorrectly by payors.
• Ensures accounts are set up correctly in AR software and verify eligibility.
• Understands contract reimbursement rates for carriers/networks.
• Examines documents for accuracy and completeness per detailed instructions.
• Meets minimum production and quality standards.
• Manages own worklist and resolves no response and denied claims.
• Maintains Over 90 aging quality measures per payer baselines.
• Other tasks as assigned.

Skills

Insurance follow up

Denials management

Appeals processing

CPT & Diagnosis Coding

Medical Terminology

Anatomy basics

Education

High School Diploma / GED

Job description

Optum is hiring an Insurance Follow Up Representative for a full-time remote role serving the Pacific and Mountain Time zones. The position focuses on obtaining timely payments, resolving denials, and writing appeals while adhering to payer guidelines and CMS 1500 processes.

The candidate should have 2+ years in insurance follow up, CPT/Diagnosis coding knowledge, and familiarity with EOB/REMITS. Flexible shifts during 7:00 am–3:30 pm PST, with occasional overtime.