Follow Up Specialist

Position Purpose:

The Medical Insurance Follow-Up Specialist is responsible for the timely and effective follow-up on outstanding insurance claims to ensure accurate and prompt reimbursement. This role involves analyzing account activity, investigating denied or unpaid claims, and working with insurance payers and internal departments to resolve issues and expedite payment. The ideal candidate is detail-oriented, organized, and experienced in medical billing and insurance claim processing.

Organization:

This position reports to the Revenue Cycle/Follow Up Manager.

Essential Job Functions include the following. Other duties may be assigned. Core responsibilities are consistent across tiers, with expectations for increased independence, complexity, and specialization at higher levels. Tier is determined based on experience, skills and performance within the role.

• Follow up on assigned insurance claims to ensure timely and accurate payment.
• Review Explanation of Benefits (EOBs) and remittance advice for payment accuracy and claim status.
• Contact insurance companies via phone, web portals, or written communication to resolve claim issues.
• Identify and appeal denied or underpaid claims based on payer guidelines and documentation.
• Collaborate with billing, coding, and clinical staff to obtain necessary documentation for claims resolution.
• Update patient account notes in the billing system with clear and concise follow-up actions and outcomes.
• Monitor aging reports and prioritize work based on payer deadlines and account balance.
• Ensure compliance with federal, state, and payer-specific regulations and policies.
• Meet individual and team performance goals, including productivity and quality standards.
• Participate in departmental meetings, training sessions, and quality improvement initiatives as required.

Required Knowledge & Experience:

• High school diploma or equivalent required; Associate's degree in healthcare or business preferred.
• Minimum of 2 years of experience in medical billing, insurance follow-up, or revenue cycle operations.
• Knowledge of insurance payer requirements, CPT/ICD coding, and medical terminology.
• Strong understanding of healthcare claim submission and adjudication processes.
• Experience working with electronic health records (EHRs) and billing systems (e.g., Epic, Meditech, Artiva, etc.).
• Excellent verbal and written communication skills.
• Ability to work independently, manage time effectively, and handle multiple priorities.
• Strong analytical and problem-solving skills

General Areas of Accountability:

Must conduct business and personal affairs in a manner that is always a credit to the company. Must maintain a good credit rating while employed with the company.

The following HIPAA and Privacy items apply to all positions at Signature Performance:

• Follow HIPAA guidelines for protecting the privacy and security of sensitive personal and/or health information.
• Follow Signature expected acceptable use to protect propriety and company owned information.
• Complete annually required Privacy and Security Training

PERFORMANCE MANAGEMENT:

All Signature Performance associates are subject to regular performance management to determine if skills and training requirements are suitable for the position.

Machines and Equipment:

The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as copiers and fax machines.

SECURITY REQUIREMENTS:

• U.S. Citizenship, naturalized citizenship, or permanent status is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Physical Activity:

The incumbent must be able to finger, grasp, feel, see, sit, hear, and speak. This position is sedentary in nature with minimal lifting requirements.

WORKING CONDITIONS:

The incumbent works in an office environment that is not substantially exposed to adverse environmental conditions such as heat, cold, or extreme noise. Routine periods of being on the phone utilizing a headset, sitting and data keying are required.

Remote Eligibility: This position is full-time remote eligible. Eligibility is determined by Management or Talent Operations.

The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.