Job Details

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 for non-government payers across three acute hospitals. This role focuses on resolving underpayments, denials, and contract interpretation issues—not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers.

Primary Responsibilities:

Claims Management:

• Take ownership of 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 issues related to coding, coordination of benefits (COBs), charge discrepancies, and contract interpretation.

• 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.

• Exclude government payers such as Medicare, Medicaid, and Tricare.

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

Analytical Review:

• Differentiate between pricing errors vs. payment errors.

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

• Escalate clinical denials to designated team members (e.g., Duwayne).

Scope of Work:

• Focus exclusively on insurance balances—no patient balance follow-up.

• Work within a non-ambulatory setting, overseeing balances once claims are billed.

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 ...@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

Skills and Requirements

• High school diploma or equivalent

• Claims Follow-Up & Appeals:

o Proven experience in insurance follow-up and appeals handling.

• Hospital billing experience

• 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).

• Healthcare Reimbursement:

o Experience in navigating billing and reimbursement processes specific to hospital settings.

• EOB Interpretation:

o Ability to read and interpret Explanation of Benefits (EOBs) and understand payer methodologies.

• Analytical Thinking:

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

• Appeals Evaluation:

o Skilled in evaluating appeals and conducting timely follow-ups with payers to ensure resolution and reimbursement.

• Attention to Detail:

o Must be able to spot errors and inconsistencies in claims and 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