Insurance Follow-Up Representative II

Position: Insurance Follow-Up Representative IIOpenings: 1Location: REMOTE (Quarterly in-house requirement for team-building)Looking for someone in Tri-state area (MD, DC, PA, VA, NJ, NY)Shift: M-F 8:00-4:30 ETDuration: 6-month contract to hireInterview: 1&done – 30 min. on Microsoft TeamsPR: $19-25/hr

Check you match the skill requirements for this role, as well as associated experience, then apply with your CV below.
Equipment: will be sent laptop/ equipment
Must Haves:High school diploma or equivalent3+ years experience in patient accounting/accounts receivable or related healthcare field.Experience with Outpatient AND Inpatient hospital billingIncluding experience with Maryland billingExperience with facility claims follow-up & appeals handlingExperience with UB04 formsThis team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.)Strong experience working with commercial (non-gov) payers (UHC, Aetna, Cigna, Medicare Advantage Plans, BCBS, etc.)Experience working specifically with BlueCross BlueShield CareFirst and/or BlueCardFamiliarity using payer portal, their escalation process, how to read and interpret contractsExperience meeting a productivity standard of following up on ~60 claims per day (95% accuracy)Knowledgeable of ICD codes, CPT Codes, EOB, etc.Attention to Detail:Must be able to spot errors and inconsistencies in claims and contracts.Analytical Thinking:Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly.Independent & Fast LearnerTech Savvy (Excel, Teams, etc.) and experience working fully remotely
Preferred:Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

Team Structure22–23 total team members: Director, Manager, 2 Supervisors, 3 Team Leads.Reporting to Team Lead (Blue Cross Follow-Up) and Supervisor.
Day to Day:Insight Global is looking for a Follow-Up Representative II to support facility claims and technical denials for a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, claim activity. This role focuses on resolving underpayments, denials, and contract interpretation issues—not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with commercial payers. This team focuses on facility claims only, and this role is focused only on claims follow up, specifically to commercial payers, including BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).
Primary Responsibilities:Claims Management:Take ownership of hospital (inpatient and outpatient) claims after billing, especially those that are denied or underpaid.Determine what was paid, what was denied, and why.Identify and resolve technical denials related to coding, underpayments or partial payments, denials, and contract interpretation issues.Manage 60 accounts per dayPayer Interaction:Handle all claims for Blue Cross Blue Sheild CareFirst and/or BlueCard.Understand and navigate multiple contracts.Utilize BCBS portal to follow up and resolve outstanding claim issues.Interpret Explanation of Benefits (EOB) and payer methodology.Analytical Review:Differentiate between pricing errors vs. payment errors.Accurately price claims based on contract terms and identify variances. xzbcwsv Scope of Work:Facility claims ONLYCommercial payers ONLY (non-government payers)
Compensation:$19 - $25per hour
Exact compensation may vary based on several factors, including skills, experience, and education.