Insurance Follow Up Representative

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.

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is received for all FMG providers.
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.

Job Requirements

Required

• High School Graduate, upon hire or
• High School GED, upon hire and
• None, upon hire

Preferred

• Other Graduation from a post-high school program in medical billing or other business-related field and Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities. , upon hire

Where You’ll Work

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.