Medical Claims Follow- up Specialist

Description

**Medical Claims Follow- up Specialist**

**Reports To:**Credentialing, Contracts & Medical Claims Manager

**Department:**Finance

**Pay Range:** $18-$21 an hour

**Essential Duties & Responsibilities**

**Claims Follow-Up & Resolution**

• Perform active, high-volume follow-up on unpaid, delayed, and aging claims across all service lines and payers using payer portals, telephone, and written correspondence.
• Monitor claims aging reports to prioritize follow-up activity and prevent timely filing losses.
• Troubleshoot claim issues by researching payer responses, remittance advice, and system records to identify the root cause of non-payment or denial.
• Communicate with payers through appropriate channels to resolve outstanding balances and obtain payment status updates.
• Identify patterns in denials or payment delays and escalate trends to the Credentialing, Contracts & Medical Claims Manager.
• Support the appeals process with guidance from leadership; escalate complex or high-value appeals as needed.
• Maintain awareness of payer-specific follow-up requirements, timely filing windows, and claim dispute processes across multiple state Medicaid programs and managed care organizations.

**Payment Posting & Denial Management**

• Post payments and denials into TherapyNotes and RevConnect accurately and within established turnaround standards.
• Reconcile posted payments against remittance advice and payer explanations of benefits (EOBs) to ensure accuracy.
• Identify underpayments, contractual adjustments, and erroneous denials and take appropriate action or escalate as needed.
• Ensure denial reason codes are accurately captured and documented to support reporting and root cause analysis.

**Claim Routing & Collaboration**

• Route unpaid or denied claims requiring correction or resubmission to the Claims Specialist – Submission with clear, documented instructions regarding the required action.
• Collaborate with the Claims Specialist – Submission to ensure routed claims are resolved and resubmitted within payer timelines.
• Coordinate with the Credentialing, Contracts & Medical Claims Manager to resolve complex payer issues, authorization discrepancies, or contract-related denials.
• Communicate effectively with internal departments including admissions, clinical, and accounting to resolve documentation or eligibility issues contributing to non-payment.

**Documentation & Audit Support**

• Log all follow-up activity, payment posting, and claim dispositions in TherapyNotes and RevConnect in a clear, complete, and audit-ready format.
• Maintain organized records of denial rationale, appeal submissions, and resolution outcomes.
• Support month-end close activities by ensuring outstanding claims and payment postings are current and accurately reflected in the claims system.
• Adhere to HIPAA requirements and internal policies governing the handling of confidential patient and financial information.

**Productivity & Continuous Improvement**

• Meet or exceed weekly and monthly productivity, resolution, and posting turnaround standards established by leadership.
• Adapt to payer rule changes, new service line rollouts, and internal workflow improvements.
• Participate in cross-training and provide backup support to the Claims Specialist – Submission as directed.
• Contribute to process improvement efforts aimed at reducing denial rates, accelerating collections, and improving claims system accuracy.

**Qualifications**

• High School Diploma or GED required.
• Minimum two years of medical claims follow-up, accounts receivable, or insurance billing experience required, with an emphasis in government payers.
• Experience in behavioral health billing and follow-up strongly preferred.
• Comfort with multi-state claims and payer guidelines preferred.
• Proficiency with Microsoft Office (Excel, Outlook, Teams) and EMR or claims management software required.
• Experience with TherapyNotes or RevConnect a plus.

**Knowledge, Skills, and Abilities**

• Strong attention to detail and accuracy in payment posting and claim documentation.
• Persistence and sound judgment in navigating payer representatives, portals, and appeals processes.
• Ability to manage a high volume of outstanding claims simultaneously while maintaining accuracy and meeting deadlines.
• Working knowledge of Medicaid, managed care, and commercial payer billing requirements, denial codes, and remittance processes.
• Understanding of revenue cycle workflows, including the relationship between claims submission, follow-up, and payment posting.
• Excellent written and verbal communication skills, including comfort with payer-facing correspondence.
• High level of integrity and discretion when handling confidential patient and financial information.
• Team-oriented with a commitment to supporting organizational cash flow and billing compliance.

**Lakemary provides competitive compensation and benefit package including medical, dental, vision, and life insurance plans; paid time off; and a 401(k)-retirement plan**

**Certifications:**

Lakemary provides training in program specific coursework.

**Special Considerations:**

Some environments/shifts require same sex staff due to regulatory requirements.

**All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. EEO**

**Diversity, Equity, and Inclusion (DEI) Statement:**

For the last 50 years we have been working to create workplaces that reflect the communities we serve and a place where everyone feels empowered to bring their full, authentic selves to work. We embrace this from our mission.