Insurance Follow-up Specialist - Vidant Health : Job Details

Job Description ECU Health About ECU HealthECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.Position Summary The Insurance Follow-up Specialist ensures that the healthcare provider and facility receive timely and accurate payments from insurance companies. This position involves thorough follow-up on outstanding claims and working to resolve any issues that may delay payment. The Insurance Follow-up Specialist ensures the efficient management of insurance claims, contributing to the financial stability and operational success of the healthcare provider and facility.Responsibilities Regularly review and monitor outstanding insurance claims to ensure timely resolution and payment.Identify and prioritize high-value or aged claims for immediate follow-up.Contact insurance companies via phone, email, or electronic portals to inquire about the status of unpaid claims.Escalate issues to insurance representatives or supervisors when necessary to expedite resolution.Document all communication and actions taken on each claim in the billing system.Update patient accounts with the current status of claims and expected payment dates.Resubmit corrected claims to insurance companies when errors are identified.Work closely with billing, and coding teams to resolve discrepancies and ensure accurate claims submission.Communicate effectively with healthcare providers and clinical staff to obtain additional information or clarification needed for claims processing.Assist patients with calling their insurance plans to resolve claim processing issues.Document detailed and organized follow-up activities, including communication logs, and claim statuses.Ensure that documentation is complete and compliant with internal policies and external regulations.Identify opportunities for process improvements to enhance the efficiency and effectiveness of claims follow-up.Ensure that all follow-up activities comply with federal and state regulations, as well as payer-specific requirements.Adhere to HIPAA guidelines to protect patient information and maintain confidentiality.Stay updated on changes in insurance guidelines, billing regulations, and industry best practices.Participate in training and professional development opportunities to maintain and enhance expertise in insurance follow-up procedures.Minimum Requirements Required Education/Course(s)/Training: High school diploma/equivalent, or higher5+ years of experience in A/R follow-up Required Certification/Registration: Certified Revenue Cycle Representative (CRCR), preferred Skill Set Requirement: Ability to analyze claims, identify issues, and develop solutionsHigh level of accuracy and attention to detail in reviewing and following up on claimsStrong analytical and problem-solving skills to identify and resolve issues related to claims processingExcellent verbal and written communication skills for effective interaction with insurance representatives, patients, and internal teamsUnderstanding of healthcare billing regulations, HIPAA compliance, and insurance guidelinesProficient in payment review systems, hospital information systems, and coding methodologiesIntermediate knowledge of CPT, ICD-10, and HCPCS coding standardsUnderstanding of insurance terms and payment methodologiesOther Information Hybrid role in Greenville, NCMonday - Friday day shiftGreat Benefits #LI-HYBRID #LI-AH2 General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.