Insight Global
Overview
Insight Global is seeking an experienced Outpatient Facility Claim Follow-Up Representative to support a major hospital system in the Maryland/DC region. This role focuses on post-billing claim activity for Blue Cross Blue Shield across three acute care hospitals in Washington, DC, specifically on outpatient facility claims and technical denials to ensure accurate reimbursement. Key Responsibilities
Claims Management: Manage outpatient hospital claims post-billing, particularly those denied or underpaid. Investigate payment outcomes and determine root causes of denials. Resolve technical denials including issues related to coding, coordination of benefits (COB), charge discrepancies, and contract interpretation. Payer Interaction: Handle all outpatient claims for BlueCross BlueShield CareFirst and/or BlueCard. Navigate payer portals and escalation processes effectively. Interpret and apply contract terms to resolve claim issues. Analytical Review: Distinguish between pricing and payment errors. Accurately price claims and identify discrepancies based on contract terms. Scope of Work: Outpatient facility claims only. Technical denials only (e.g., underpayment, authorization, COB, coding, contract misinterpretation). Required Qualifications
High school diploma or equivalent. Experience in outpatient hospital billing. Proven background in facility claims follow-up and appeals handling. Familiarity with UB04 forms. Strong experience with BlueCross BlueShield CareFirst and/or BlueCard. Ability to meet productivity standards (~55 claims per day). Proficient in ICD and CPT coding. Exceptional attention to detail and analytical thinking. Ability to work independently and learn quickly. Comfortable working in a fully remote environment. Technologically proficient (Excel, Microsoft Teams, etc.). Preferred Experience
Familiarity with systems such as Med-Connect (medical records), RCI (denials repository), Envision (SMS), and Epic. Seniority level
Associate Employment type
Contract Job function
Accounting/Auditing Industries
Hospitals and Health Care
#J-18808-Ljbffr
Insight Global is seeking an experienced Outpatient Facility Claim Follow-Up Representative to support a major hospital system in the Maryland/DC region. This role focuses on post-billing claim activity for Blue Cross Blue Shield across three acute care hospitals in Washington, DC, specifically on outpatient facility claims and technical denials to ensure accurate reimbursement. Key Responsibilities
Claims Management: Manage outpatient hospital claims post-billing, particularly those denied or underpaid. Investigate payment outcomes and determine root causes of denials. Resolve technical denials including issues related to coding, coordination of benefits (COB), charge discrepancies, and contract interpretation. Payer Interaction: Handle all outpatient claims for BlueCross BlueShield CareFirst and/or BlueCard. Navigate payer portals and escalation processes effectively. Interpret and apply contract terms to resolve claim issues. Analytical Review: Distinguish between pricing and payment errors. Accurately price claims and identify discrepancies based on contract terms. Scope of Work: Outpatient facility claims only. Technical denials only (e.g., underpayment, authorization, COB, coding, contract misinterpretation). Required Qualifications
High school diploma or equivalent. Experience in outpatient hospital billing. Proven background in facility claims follow-up and appeals handling. Familiarity with UB04 forms. Strong experience with BlueCross BlueShield CareFirst and/or BlueCard. Ability to meet productivity standards (~55 claims per day). Proficient in ICD and CPT coding. Exceptional attention to detail and analytical thinking. Ability to work independently and learn quickly. Comfortable working in a fully remote environment. Technologically proficient (Excel, Microsoft Teams, etc.). Preferred Experience
Familiarity with systems such as Med-Connect (medical records), RCI (denials repository), Envision (SMS), and Epic. Seniority level
Associate Employment type
Contract Job function
Accounting/Auditing Industries
Hospitals and Health Care
#J-18808-Ljbffr