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Bayhealth · 1 day ago

Insurance Follow-Up Specialist

Dover, DE

Full-time

Onsite

Mid Level

$19.18/hr - $28.77/hr

3+ years exp

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader, and they are seeking an Insurance Follow-Up and Collections Specialist. This role is responsible for following up on hospital and professional insurance claims, requiring advanced knowledge of payers and claim types to ensure timely billing and cash flow.

Emergency MedicineHealth CareHospital

H1B Sponsor Likely

Responsibilities

Follows up on unpaid claims and appeals via telephone or web-based claim inquiries. Completes imaging system correspondence work queue(s) as appropriate. Identifies and performs appropriate contract and/or other denial related write offs. Research missing payments via undistributed work queues and apply the payment to the correct invoice. Documents accounts thoroughly and appropriately with all information concerning claim and expected payment status and necessary follow up action taken to secure payment

Verifies insurance eligibility, corrects claim errors, submits claim reconsiderations, writes appeals, and provides requested information to resolve denied claims. Interacts with various long term care offices to correct denials as appropriate

Interprets payer denials, reviews submitted claim information, and medical records to understand the denial. Refers denied claims to correct department work queue with coding recommendations or other clarification questions as needed to resolve the denial; resubmits denied claims with revised information. Refers patients for Financial Assistance based on Medicare/Medicaid benefits exhausted and delayed lower level of care placement scenarios

As applicable, converts denied inpatient admissions to observation claims based on the insurance company approving observation

Contacts patients to resolve insurance company-initiated information requests as needed to facilitate claim payment

Reviews and interprets Federal and State regulations for Medicare and Medicaid and contract terms for Managed Care, Commercial, and Workers Compensation as applicable

Understands Bayhealth’s contracted reimbursement rates. Reviews insurance company payment variances and, as needed, calculates expected reimbursement for outlier claims and claims with days denied as not medically necessary. Pursues underpaid claims and submits overpayments for refunds. Documents inappropriate denial and payment variances on spreadsheets, participates in calls with insurance company provider representatives, and accurately communicates variance reasons and expected resolution

Processes credit balances; submits overpayments electronically to insurance companies who require electronic submission to correct the overpayment. As applicable, reviews the third-party vendor submitted refunds for accuracy

Escalates insurance company and internal claim related issues to management as appropriate for resolution

Serves as a subject matter expert for colleagues internal and external to PFS. Accurately researches payer issues and provides payer/plan specific education on billing and/or claim requirements. Ensures requests for system and process changes are thoroughly examined before making management recommendations

As appropriate, performs Medicare and Medicare Advantage transfer DRG recoveries. Thoroughly researches the Medicare Direct Data Entry system, contacting sub acute facilities and home health agencies as needed to determine revenue recovery opportunities. Submits necessary adjusted claims to recover withheld revenue within payer filing limits. Tracks all claim findings and results in Excel spreadsheet and reports results to management monthly

Maintains established department productivity minimums

All other duties as assigned within the scope and range of job responsibilities

Qualification

Insurance claims processingBillingCollectionsPayer denials interpretationMedicare regulations knowledgeExcel proficiencyCommunication skillsProblem-solving skillsTeam collaboration

Required

High School Diploma or GED

Three years' experience in hospital and/or physician billing and collections

Preferred

Four years hospital billing or collections experience

Associate Degree

Certified Revenue Cycle Specialist

Benefits

Generous Paid Time Off and Paid Holidays

Matching 401(k)/403(b) Plans

Excellent Health, Dental, and Vision

Disability and Life Insurance options

On Site Child Care

Educational Reimbursement

Health Care and Dependent Care Flex Spending Accounts

Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Company

Bayhealth

Bayhealth is an advanced non-profit healthcare system that provides penn medicine for heart, vascular, cancer and orthopaedics.

Founded in 2010

Dover, Delaware, USA

1001-5000 employees

https://www.bayhealth.org/

H1B Sponsorship

Bayhealth has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (20)

2024 (25)

2023 (17)

2022 (16)

2021 (12)

2020 (10)