Job Description

Job Description

Job Description

Must Haves:

• High school diploma or equivalent
• 3-5+ years experience in patient accounting/accounts receivable or related healthcare 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 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 BlueCard
• • Familiarity using payer portal, their escalation process, how to read and interpret contracts
• Experience meeting a productivity standard of following up on ~80 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 Learner
• Tech 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 Structure

• 22–23 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 Commercial Follow-Up Representative 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, specifically for Blue Cross Blue Shield, 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 day

Payer 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.

Scope of Work:

• Facility claims ONLY
• Commercial payers ONLY (non-government payers)

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