Inpatient Facility Claim Follow-Up Representative

Job Description

Job Description

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)

Experience using payer portals

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

Must be able to spot errors and inconsistencies in claims and contracts.

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

Preferred :

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 :

Payer Interaction :

Analytical Review :

Scope of Work :