Role Description
The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives reimbursement from government and commercial payers. The ideal candidate has strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.
Roles & Responsibilities
Claim Follow-Up - PB & HB
- Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone calls, payer websites, and Epic work queues to ensure timely reimbursement.
- Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments.
- Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
- Identify payer trends and payment discrepancies across both PB and HB claim types and escalate findings to leadership.
- Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable.
- Escalate claims with payers for resolution on inaccurate or delayed claim processing.
Appeals & Reconsiderations
- Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification.
- Adhere to payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.
Payer & System Knowledge
- Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data.
- Utilize payer portals (Availity, NaviMedix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs.
- Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.
Compliance & Documentation
- Ensure accurate and detailed documentation of all follow-up activities in Epic.
- Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections.
- Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies.
- Always maintain confidentiality of patient and account information (HIPAA).
- Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct.
- Maintain awareness of and actively participate in the Corporate Compliance Program.
- Maintain a confidential and orderly remote work area.
- Meet specified goals and objectives assigned by management and/or the Client.
- Assist with other projects as assigned by management.
Expected / Key Results
- Deliver high levels of client and patient satisfaction (CSAT)
- Achieve quality scores per defined process standards
- Deliver defined process-specific metrics (e.g., AR days, cash collected, productivity units)
- Adherence to regulatory compliance requirements
- Schedule adherence
Preferred Educational Qualifications
- High school diploma or equivalent required
- Associate's or Bachelor's degree in Health Information Management, Business, or related field preferred
Preferred Work Experience
- 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up
- Demonstrated experience working PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up
- Prior experience with Epic billing and/or follow-up work queues strongly preferred
- Familiarity with Medicaid, Medicare, and commercial payers preferred
- Experience reading and interpreting 835 ERA / EOB remittance data
Competencies & Skills
- Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes
- Proficiency with Epic (HB and/or PB modules, work queues, claim correction, and rebilling)
- Familiarity with CARC/RARC denial and adjustment reason codes
- Ability to interpret EOB, ERA (835), and remittance advice for both PB and HB claims
- Knowledge of payer portals including Availity, Arkansas DHS, and commercial payer sites
- Competent in working and communicating effectively with payers, patients, colleagues, and management - both in-person and via remote virtual platforms
- Consistently maintains a courteous and professional demeanor
- Self-motivated with the ability to stay focused and productive with minimal supervision
- Proactive initiative and creative problem-solving in carrying out job responsibilities
- Ability to prioritize multiple tasks through effective time management and organizational skills
- Proficiency in PC operations; ability to type at a rate of 30-40 words per minute
Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.
We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.
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