Insurance Billing & Follow-Up Specialist

SUMMARY
At ZoomCare we are working hard to make healthcare easy. Our mission is to deliver innovative, high-quality, convenient healthcare when patients need it. We offer same-day, no-wait visits in urgent care, primary care, and specialty care and we’re expanding from our roots in the Pacific Northwest to new markets. We hope you will apply to become part of our dedicated, fast-moving team of superstars!
ZoomCare is seeking an Insurance Follow Up Specialist to join our team!
The Follow-up Specialist is responsible for resolving outstanding insurance claims to maximize reimbursement and reduce accounts receivable days. This position focuses on identifying, researching, and rectifying claim denials and delays for professional services through effective communication with insurance payers and internal departments.
SCHEDULE AND TRAINING
Monday – Friday | 9:00am-5:30pm flex schedule.
Candidates must reside in Oregon or Washington
Depending on the position and associated requirements, there may be additional mandatory training requirements that are outside of your scheduled shift.
ESSENTIAL FUNCTIONS
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Represent our values: Awesome, Creative, Respectful, Team Players, Get it Done.
Work unpaid and partially paid insurance claims to resolve outstanding balances and secure accurate reimbursement in accordance with payer guidelines.
Research claim status by utilizing insurance portals, conducting phone outreach, and drafting written correspondence as needed.
Analyze denied or underpaid claims to identify root causes, trends, and necessary corrective actions.
Submit timely and well-documented appeals for denied claims in alignment with specific payer policies and appeal procedures.
Resubmit corrected claims with updated coding, documentation, or demographic information to facilitate proper adjudication.
Maintain thorough and accurate records of all claim follow-up activities within the billing or revenue cycle management system.
Collaborate with coding teams, clinical documentation specialists, and provider offices to gather missing information or resolve claim discrepancies.
Monitor aging accounts and prioritize claims based on timely filing limits and payer response windows.
Identify systemic issues or process inefficiencies impacting claim resolution and escalate concerns to management with supporting documentation.
Meet or exceed established productivity and quality benchmarks while adhering to compliance and privacy standards.
Other duties as assigned.
QUALIFICATIONS
High school diploma or equivalent required; associate’s degree in healthcare administration, Business, or a related field preferred.
2+ years of experience in medical billing, with a focus on professional billing and accounts receivable follow-up.
Solid understanding of CPT, HCPCS, and ICD-10 coding systems and their application in claim submission and reimbursement.
Experience working with electronic billing systems and payer portals to manage claim status, denials, and appeals.
Familiarity with insurance reimbursement methodologies, claim adjudication processes, and payer-specific requirements.