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REMOTE Inpatient Facility Claim Follow-Up Representative

REMOTE Inpatient Facility Claim Follow-Up Representative

Insight Global HealthcareBaltimore, MD, US
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Job Description

Job Description

FULLY REMOTE!

Shift : M-F 8 : 00am-4 : 30pm EST

Duration :  6-month contract with potential to extend and / or convert

Must Haves :

  • High school diploma or equivalent
  • INPATIENT!!!  Hospital billing  experience
  • Experience with  UB04 forms
  • Experience with insurance claims follow-up & appeals handling

Knowledge of  DRG codes  (used only in inpatient billing)

  • 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  payers (UHC, Aetna, Cigna, BCBS, Medicare Advantage Plans, etc.)

    • Experience using payer portals

  • Strong experience reading and  interpreting payer contracts  (especially outside Maryland).

    • Must understand that payers like United may have multiple contract variations (e.g., 7 different contracts).

  • Knowledgeable of ICD + CPT Codes
  • Experience meeting a productivity standard of following up on ~55 claims per day.
  • 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

    • Day to Day :

    Insight Global is looking for Inpatient Insurance Claim 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 for non-government payers across three acute hospitals in Washington DC. This team focuses on facility claims only, and this role is focused only on inpatient claims follow up. 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 inpatient hospital claims  after billing , especially those that are  denied or underpaid .

  • Review EOBs and contracts to determine  what was paid, what was denied, and why .
  • Identify and resolve technical denials related to  coding, coordination of benefits (COBs), charge discrepancies ,  contract interpretation , etc.
  • Utilize payer portals to follow up and resolve outstanding claim issues.
  • Payer Interaction :

    • Handle  all commercial payers  including Aetna, Blue Cross, UnitedHealthcare, Cigna, and Medicare Advantage plans.

  • Understand and navigate  multiple contracts per payer .
  • Analytical Review :

    • Differentiate between  pricing errors vs. payment errors .

  • Accurately  price claims  based on contract terms and identify variances.

    • Scope of Work :

  • Inpatient facility claims ONLY
  • Technical denials ONLY

    • Company Description

    At Insight Global, we’re more than just a staffing agency — we’re a people-first solutions firm that believes in the power of connection. With a nationwide presence and a reputation built on trust, integrity, and results, we specialize in placing top-tier talent across healthcare, IT, education, engineering, and professional services.

    Company Description

    At Insight Global, we’re more than just a staffing agency — we’re a people-first solutions firm that believes in the power of connection. With a nationwide presence and a reputation built on trust, integrity, and results, we specialize in placing top-tier talent across healthcare, IT, education, engineering, and professional services.

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    Claim Representative • Baltimore, MD, US