Insurance, Provider & Patient Follow-Up Specialist

(Confidential Healthcare Organization)Full-Time | Remote

Role Overview

We are seeking a highly drivenInsurance, Provider & Patient Follow-Up Specialistto support critical outbound workflows that directly impact patient access to care and revenue collection.

This role is responsible for proactively following up withinsurance companies, medical providers, and patientsto move authorizations, claims, and payments to resolution. You will navigate complex insurance processes, track down required clinical documentation, resolve denied claims, and communicate clearly with patients regarding financial responsibility.

This position is ideal for someone who is persistent, detail-oriented, and comfortable operating in fast-moving, sometimes fragmented healthcare systems.

Key Responsibilities

Insurance & Authorization Follow-Up
* Proactively contact insurance carriers to expedite prior authorizations and approval timelines
Proactively contact insurance carriers to expedite prior authorizations and approval timelines
* Track authorization status and follow up persistently until resolution
Track authorization status and follow up persistently until resolution

Provider & Documentation Coordination
* Follow up with physician offices to obtain prescriptions, clinical notes, Letters of Medical Necessity (LMNs), and corrected or missing documentation
Follow up with physician offices to obtain prescriptions, clinical notes, Letters of Medical Necessity (LMNs), and corrected or missing documentation
* Identify gaps or errors in submitted documentation and coordinate corrections
Identify gaps or errors in submitted documentation and coordinate corrections

Claims & Denial Resolution
* Monitor denied and pending insurance claims
Monitor denied and pending insurance claims
* Identify root causes of denials and pursue reprocessing or appeals to drive payment
Identify root causes of denials and pursue reprocessing or appeals to drive payment
* Maintain ownership of claims through final resolution
Maintain ownership of claims through final resolution

Patient Financial Follow-Up
* Contact patients to review and collect co-insurance, deductibles, or outstanding patient responsibility balances
Contact patients to review and collect co-insurance, deductibles, or outstanding patient responsibility balances
* Confirm payment status and provide clear, professional communication
Confirm payment status and provide clear, professional communication

Documentation & Systems
* Accurately document all outreach, conversations, and outcomes in internal systems
Accurately document all outreach, conversations, and outcomes in internal systems
* Maintain clear records to support audits, escalations, and downstream teams
Maintain clear records to support audits, escalations, and downstream teams

What Success Looks Like
* Faster insurance authorization turnaround times
Faster insurance authorization turnaround times
* Fewer claims stuck in denied or pending status
Fewer claims stuck in denied or pending status
* Increased claim and patient payment resolution rates
Increased claim and patient payment resolution rates
* Consistent, accurate documentation across all follow-up activity
Consistent, accurate documentation across all follow-up activity
* Improved patient experience through clear and professional communication
Improved patient experience through clear and professional communication

Background & Experience (Nice to Have, Not Required)
* Experience in healthcare operations, medical billing, insurance follow-up, or revenue cycle management
Experience in healthcare operations, medical billing, insurance follow-up, or revenue cycle management
* Familiarity with prior authorizations, insurance denials, and appeals processes
Familiarity with prior authorizations, insurance denials, and appeals processes
* Experience in DME, provider offices, or billing environments is a plus
Experience in DME, provider offices, or billing environments is a plus

Skills & Working Style
* Persistent, professional, and comfortable with frequent outbound phone communication
Persistent, professional, and comfortable with frequent outbound phone communication
* Resourceful and confident navigating insurance phone trees and provider office workflows
Resourceful and confident navigating insurance phone trees and provider office workflows
* Strong problem-solving skills and ability to identify the right decision-maker
Strong problem-solving skills and ability to identify the right decision-maker
* Highly organized with the ability to manage multiple open follow-ups simultaneously
Highly organized with the ability to manage multiple open follow-ups simultaneously
* Calm and effective when handling friction, delays, or incomplete information
Calm and effective when handling friction, delays, or incomplete information

Work Environment
* Full-time, remote position
Full-time, remote position
* Heavy phone-based rol