Insurance Follow-Up Agent

JOB SUMMARY:

FMS, Inc. is seeking a proactive and detail-oriented Medical Insurance Follow-Up Agent to join our Revenue Cycle team. In this role, you will be responsible for ensuring timely and accurate follow-up on medical insurance claims. Your primary goal is to identify and resolve issues that prevent reimbursement, while maintaining compliance with all payer and regulatory guidelines.

JOB DUTIES AND RESPONSIBILITIES:

• Conduct timely follow-up on outstanding insurance claims via phone, online portals, or written correspondence.
• Investigate and resolve denied, delayed, or underpaid claims by communicating with insurance companies and third-party payers.
• Review Explanation of Benefits (EOBs) and remittance advice to ensure proper claim adjudication.
• Identify trends in denials or payment delays and escalate issues as necessary.
• Document all claim activity and communications accurately in the billing system.
• Verify insurance coverage and eligibility when required for follow-up activities.
• Collaborate with billing, coding, and patient services teams to resolve discrepancies.
• Maintain compliance with HIPAA and other applicable laws and guidelines related to medical billing and patient privacy.
• Meet department productivity and quality standards.

JOB QUALIFICATIONS:

• Education:
• High school diploma or equivalent required.
• Associate degree or coursework in healthcare administration, billing, or a related field preferred.
• Experience:
• 1+ year of experience in medical billing, insurance follow-up, or healthcare collections required.
• Familiarity with commercial, Medicare, and Medicaid insurance plans strongly preferred.
• Skills & Competencies:
• Strong knowledge of EOBs, claim denials, appeals, and reimbursement processes.
• Excellent verbal and written communication skills.
• Strong organizational and time management skills.
• Proficiency in medical billing software and Microsoft Office (Excel, Outlook, Word).
• Ability to work independently and as part of a team.
• High attention to detail and accuracy.
• Proficient typist with ability to operate and navigate multiple computer systems with ease.

WORK-FROM-HOME REQUIREMENTS:

• Reliable high-speed internet and secure, quiet workspace
• Employee-provided WFH equipment
• Desktop & Dual Monitors - 4vCPU with minimum 1.6 GHz or faster processor. For higher video/screen share resolution and frame rate, a four-core processor or better is required
• RAM: 8000 MB
• Hard Drive: 6 GB or more
• .NET Framework version 4.6.1 or later
• Windows 10/11
• Mouse
• Headset
• Webcam
• Comfortable using video conferencing tools throughout each scheduled shift
• Ability to maintain confidentiality and protect patient health information (PHI) in a remote environment