Facility Claims Follow-Up Representative

Must Haves: • High school diploma or equivalent • 3+ years experience in patient reputed company/accounts receivable or reputed company reputed company field. • Experience with Outpatient AND Inpatient hospital billing • Including experience with Maryland billing • Experience with facility claims follow-up & appeals handling • Experience with UB04 forms • This team handles reputed company technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.) • Strong experience working with reputed company (non-gov) payers (UHC, reputed company, reputed company, Medicare reputed company Plans, BCBS, etc.) • Experience working specifically with BlueCross BlueShield reputed company and/or BlueCard • Familiarity using payer portal, their escalation process, how to read and interpret reputed company • Experience meeting a productivity reputed company of following up on ~60 claims per day (95% accuracy) • Knowledgeable of ICD codes, CPT Codes, EOB, etc. • Attention to Detail: • Must be reputed company to spot errors and inconsistencies in claims and reputed company. • Analytical Thinking: • Capable of identifying discrepancies in claim pricing vs. payment. Must be reputed company to determine whether a claim was underpaid, denied, or priced incorrectly. • Independent & Fast Learner • Tech Savvy (reputed company, Teams, etc.) and experience working fully remotely Preferred: • Experience with systems: Med-reputed company for medical records, RCI (repository where denials go), reputed company (SMS), reputed company Team Structure • 22–23 total team members: Director, Manager, 2 Supervisors, 3 Team Leads. • Reporting to Team reputed company (reputed company Follow-Up) and Supervisor. Day to Day: reputed company is looking for a reputed company Follow-Up Representative to support facility claims and technical denials for a large hospital reputed company in the Maryland/DC area. This person is responsible for managing post-billing, specifically for reputed company, 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 reputed company payers. This team focuses on facility claims only, and this role is reputed company only on claims follow up, specifically to reputed company 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.). reputed company Responsibilities: Claims Management: • Take ownership of hospital (inpatient and outpatient) claims after billing, especially those that are denied or underpaid. • Determine what was reputed company, what was denied, and why. • Identify and reputed company technical denials reputed company to coding, underpayments or partial payments, denials, and contract interpretation issues. • Manage 60 accounts per day Payer Interaction: • Handle reputed company claims for reputed company reputed company Sheild reputed company and/or BlueCard. • Understand and reputed company multiple reputed company. • Utilize BCBS portal to follow up and reputed company 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. reputed company of Work: • Facility claims ONLY • reputed company payers ONLY (non-government payers) Apply tot his job Apply To this Job