UT Health San Antonio
Insurance Follow Up Specialist- Senior
UT Health San Antonio, San Antonio, Texas, United States, 78208
Overview
Insurance Follow Up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members. Onsite training 4-6 weeks, then fully remote. Address: 8431 Fredericksburg Rd., 78229. Responsibilities
Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials. Verify patient benefits and insurance eligibility, perform claims status verification, navigate insurance websites for payor guidelines, and communicate findings to insurance companies, management teams, and clinical departments. Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes. Review and respond to insurance correspondence related to recoupments, refunds, eligibility, or additional requests from payors. Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records. Lead and participate in special projects, help define and streamline workflows, and manage high-complexity work queues and claims. Meet or exceed production standards to resolve outstanding claims and maintain healthy accounts receivable. Coordinate with Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations teams to resolve claims and patient or provider issues. Serve as liaison between affiliated hospitals and organizations to maximize collection efforts. Complete all other duties as assigned. Qualifications
Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting. Experience in medical claims follow-up for various payors. Detail-oriented with the ability to organize, prioritize, and coordinate work within schedule constraints and handle emergent requirements in a timely manner. Able to multi-task in a fast-paced, high-volume environment. Proficient in Microsoft Office software. Medical healthcare records software experience. Experience with Experian, Trizetto/Claim Logic. Experience
Minimum of five (5) years in a healthcare business office or medical billing-related experience. Hospital experience preferred. Education
High School Graduate or Equivalent Required Skills
Minimum of five (5) years in a healthcare business office or medical billing-related experience. Hospital experience preferred. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries
Higher Education
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Insurance Follow Up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members. Onsite training 4-6 weeks, then fully remote. Address: 8431 Fredericksburg Rd., 78229. Responsibilities
Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials. Verify patient benefits and insurance eligibility, perform claims status verification, navigate insurance websites for payor guidelines, and communicate findings to insurance companies, management teams, and clinical departments. Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes. Review and respond to insurance correspondence related to recoupments, refunds, eligibility, or additional requests from payors. Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records. Lead and participate in special projects, help define and streamline workflows, and manage high-complexity work queues and claims. Meet or exceed production standards to resolve outstanding claims and maintain healthy accounts receivable. Coordinate with Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations teams to resolve claims and patient or provider issues. Serve as liaison between affiliated hospitals and organizations to maximize collection efforts. Complete all other duties as assigned. Qualifications
Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting. Experience in medical claims follow-up for various payors. Detail-oriented with the ability to organize, prioritize, and coordinate work within schedule constraints and handle emergent requirements in a timely manner. Able to multi-task in a fast-paced, high-volume environment. Proficient in Microsoft Office software. Medical healthcare records software experience. Experience with Experian, Trizetto/Claim Logic. Experience
Minimum of five (5) years in a healthcare business office or medical billing-related experience. Hospital experience preferred. Education
High School Graduate or Equivalent Required Skills
Minimum of five (5) years in a healthcare business office or medical billing-related experience. Hospital experience preferred. Seniority level
Mid-Senior level Employment type
Full-time Job function
Other Industries
Higher Education
#J-18808-Ljbffr