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Job Description

Insight Global is looking for Insurance Follow Up Representative to support a large hospital system in the Maryland/DC area. The Insurance Follow-Up Representative is responsible for managing post-billing insurance claim activity, specifically focused on Blue Cross Blue Shield. This role focuses on handling technical denials for inpatient claims, focusing on issues like authorization disputes, underpayments, and coordination of benefits, distinct from clinical denials.

Primary Responsibilities:

• Handle all technical denials through Blue Cross Blue Shield.

• Understand and navigate multiple contracts per payer, especially outside Maryland’s fee-for-service structure.

• Investigate and resolve technical denials (e.g., authorization issues, coding errors, underpayments, coordination of benefits) for claims submitted to Blue Cross Blue Shield.

• Identify denial reasons and take corrective actions.

• Perform accounts receivable (A/R) follow-up on denied or partially paid inpatient claims, ensuring accurate resubmission or appeals.

• Draft and submit appeals for technical denials, using templates adjusted for specific denial reasons (e.g., missing prior authorizations or incorrect coding).

• Resolve 55 claims per day, conducting thorough investigations to address complex technical issues while maintaining a 95% accuracy standard.

• Verify coding accuracy (e.g., ICD-10-CM, ICD-10-PCS, DRG assignments) and patient information to prevent denials due to technical errors.

• Adhere to payer policies and contracts to secure appropriate reimbursement for inpatient services.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

• High school diploma or equivalent

• 3+ years inpatient hospital billing experience

o Experience with UB-04 forms

• 2+ years’ experience working specifically with Blue Cross Blue Shield

• Knowledge with Diagnosis-Related Groups (DRGs) and accounts receivable (A/R) follow-up for denied TECHNICAL claims, underpayments, and coverage issues, rather than front-end claim rejections.

• Experience meeting a productivity standard of 55 claims resolved per day, requiring in-depth investigation and resolution of complex technical denials.

o Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly.

• Contract Knowledge:

o Familiarity with payer contracts, especially outside Maryland. Must understand that payers like United may have multiple contract variations (e.g., 7 different contracts).

• Independent & Fast Learner:

• Tech Savvy (Excel, Teams, etc.) and experience working fully remotely • Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic