Insurance Follow Up Rep

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.

• Researches and resolves unpaid or underpaid insurance accounts receivable by following up with commercial and government payers, interpreting Explanation of Benefits (EOBs) and remittance advices, correcting billing system errors, and resubmitting claims as needed to ensure accurate and timely reimbursement.
• Investigates and resolves claim denials and payment discrepancies by utilizing payer portals, phone outreach, spreadsheets, and other resources; documents all account activity accurately, prioritizes work queues, escalates complex issues appropriately, and ensures compliance with organizational policies and productivity standards.
• Applies expert knowledge of billing, coding, reimbursement, and payer regulations to identify denial trends, recommend process improvements and system edits, communicate changes in billing requirements, and support compliance with HIPAA, government regulations, and contractual requirements.
• Collaborates effectively with insurance payers, clinics, and Revenue Cycle teams to resolve reimbursement issues, explain denials and underpayments, maintain positive working relationships, and provide accurate, supported communication through phone and written correspondence.
• Identifies trends and opportunities for operational improvement by analyzing denial patterns, reporting findings to leadership, assisting with staff education, supporting escalated issues, and promoting best practices that improve reimbursement and reduce future denials.
• Maintains current industry knowledge and supports departmental success by staying informed on insurance regulations, reimbursement methodologies, billing requirements, and payer-specific guidelines while providing cross-functional support within the Revenue Cycle team as needed.

Job Requirements

Required

• Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities or
• Post-high school education in a field (e.g. medical billing) that would demonstrate attainment of the requisite job knowledge/abilities may be substituted, on a month-for-month basis, for one year of the experience requirement.

 

Where You’ll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person – body, mind, and spirit – in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.