Medical Biller / Insurance Follow-Up

Job Summary

The Medical Insurance Follow-Up Representative is responsible for ensuring timely and accurate resolution of outstanding insurance claims. This position involves investigating denied, delayed, or underpaid claims, working with insurance carriers to secure proper reimbursement, and maintaining compliance with payer regulations. The representative plays a key role in supporting the organization’s revenue cycle by reducing accounts receivable (A/R) days and improving cash flow.

Key Responsibilities

• Review and follow up on outstanding insurance claims to ensure prompt payment.

• Contact insurance companies via phone, portals, or written correspondence to resolve claim issues.

• Research and analyze claim denials, rejections, and underpayments; take corrective action as needed.

• Resubmit corrected claims or appeals in compliance with payer guidelines and deadlines.

• Document all actions and communications in the patient account system accurately and timely.

• Work closely with billing, coding, and patient services staff to resolve claim discrepancies.

• Identify payer trends and escalate recurring issues to management.

• Maintain knowledge of insurance payer policies, medical billing procedures, and compliance regulations (HIPAA, CMS, etc.).

• Meet departmental goals for productivity, claim resolution, and A/R management.

• Provide excellent customer service to patients and insurance representatives.

Qualifications

• High school diploma or equivalent required; Associate’s degree in healthcare administration, business, or related field preferred.

• 1–3 years of medical billing, claims follow-up, or revenue cycle experience in a healthcare setting.

• Knowledge of insurance payers, claim submission processes, and denial management.

• Familiarity with CPT, ICD-10, HCPCS codes, and medical terminology preferred.

• Proficiency in billing software and Microsoft Office Suite (Excel, Word, Outlook).

• Strong organizational, problem-solving, and communication skills.

• Ability to work independently and in a team-oriented environment.

• Detail-oriented with strong follow-up and time management abilities.