Managed Care Follow Up Specialist

Job Summary

Working remotely in a full-time capacity, the Managed Care Follow Up Specialist will monitor and track the status of submitted reconsiderations, appeals, and disputes, ensuring timely follow-up and accurate resolution within the healthcare insurance field.

Key responsibilities

• Review outstanding hospital reconsiderations, redeterminations, and appeals for potential resolution within policy guidelines
• Manage claims resolution workflows, including 2nd level appeals and monitoring appeals for payment
• Conduct research and coordinate responses to evaluate, process, and refer or close appeals

Required qualifications

• Associate degree in Business Administration, Healthcare Administration, or a closely related field, along with 2 years of relevant work experience
• Minimum of two years in medical collections
• Basic understanding of the Revenue Cycle Process
• Experience with payor online portals
• Basic knowledge of Microsoft Applications: Outlook, Excel, Word