Insurance Follow Up Specialist

Insurance Follow-Up Specialist - Remote

Remote / Specialty Diagnostic Laboratory / Healthcare Revenue Cycle Management

Pay Rate: $28.85-$36.06 per hour
Employment Type: Temp Contract, Contract-to-Hire
Contract Length: 800 hours
Schedule: Monday-Friday, 8:00 AM-5:00 PM CST
Location: 100% remote
Education: High school diploma or equivalent required
Equipment: Provided by the client

Position Overview

We are seeking an Insurance Follow-Up Specialist to support a specialty diagnostic laboratory's revenue cycle management team. This role focuses on investigating and resolving outstanding insurance claims, administrative denials, and unresponsive appeals to help reduce a backlog of historical claims.

The ideal candidate has at least 5 years of medical billing experience, specifically in insurance claim follow-up, denial resolution, and claim processing. This individual should be persistent, analytical, and comfortable identifying patterns and resolving groups of similar claims efficiently rather than working each claim individually.

This is a fully remote, contract-to-hire opportunity with the potential to transition into a permanent position based on performance and business needs.

Key Responsibilities

• Investigate Outstanding Claims: Review claim details, denial codes, and explanations of benefits (EOBs) to identify the root causes of denials, including coding discrepancies, patient demographic errors, missing information, and administrative issues.

• Follow Up on Unresponsive Claims: Research claims submitted more than 60 days ago that have received no response, as well as previously submitted appeals with no decision or denial explanation.

• Contact Insurance Payers: Use payer portals and outbound phone calls to check claim statuses, obtain EOBs, clarify denial reasons, and determine why claims have not been processed.

• Resolve Claims in Batches: Group claims by payer or denial reason to identify common issues and efficiently resolve high volumes of similar claims through targeted investigations.

• Correct and Resubmit Claims: Update missing or inaccurate information and resubmit corrected claims within payer-specific timely filing and correction deadlines.

• Document Claim Activity: Maintain accurate records of claim investigations, payer communications, corrective actions, and follow-up efforts.

• Escalate Complex Issues: Identify claims requiring formal reconsideration or appeals and refer them to the appropriate Appeals and Denials team.

• Identify Trends and Improve Processes: Collaborate with internal departments and revenue cycle leadership to identify recurring denial patterns and recommend process improvements.

Required Qualifications

• High school diploma or equivalent.

• Minimum of 5 years of medical billing experience, specifically in insurance claim follow-up, denial resolution, and claim processing.

• Strong understanding of Medicare, Medicaid, commercial insurance plans, Managed Care Organizations (MCOs), and Medicare Advantage.

• Knowledge of payer-specific billing guidelines and timely filing requirements.

• Excellent analytical, investigative, and problem-solving skills.

• Strong verbal and written communication skills, including the ability to communicate with insurance payers and document findings accurately.

• Excellent organizational and time management skills, with the ability to prioritize high-volume work queues and meet productivity goals.

• Ability to work independently and adapt to a fast-paced, fully remote environment.

• Understanding of HIPAA requirements and appropriate handling of protected health information (PHI).

• Proficiency with healthcare billing systems, payer portals, and Microsoft Office Suite.

• Ability to identify trends and resolve claims efficiently through batch investigations.

Preferred Qualifications

• Experience with molecular laboratory billing, genetic testing, or specialty diagnostic laboratory claims.

• Familiarity with complex clinical criteria and specialized healthcare requirements.

• Background in genetic counseling or another clinical field combined with revenue cycle management experience.

• Bachelor's degree or higher.

• Experience interpreting claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), explanations of benefits (EOBs), and CPT/ICD-10 codes.

Additional Details

• 100% remote position with equipment provided.

• Focused on resolving a backlog of outstanding claims and unresponsive appeals.

• Emphasis on claim investigation, administrative resolution, and problem-solving rather than completing formal appeals.

• One-round interview process lasting approximately 30 minutes.

• Potential to convert to a permanent, full-time position based on performance and business needs.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?