Insurance Follow-up Denial Specialist I

Optim Health System

Insurance Follow-up Denial Specialist addressing insurance billing and coding issues at Optim Health. Collaborating with multiple departments to ensure accurate billing processes and customer service.

Posted 4/29/2026full-timeRemote • 🇺🇸 United StatesJuniorWebsite

About the role

Key responsibilities & impact

Protects the financial standing of Optim Health by performing functions related to the billing, coding verification, collection, payment, and customer service for all payer and patient accounts.
Under general supervision, is responsible for processing insurance and billing insurance in a timely manner.
Reviews assigned electronic claims and submission reports.
Resolves and resubmits rejected claims appropriately as necessary.
Works closely with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services departments to resolve outstanding claim errors by obtaining necessary information for accurate billing.
Processes daily error logs, stalled reports, aging claims, and any ah-hoc reports.
Addresses claim issues from insurance companies requesting additional information and/or checking status of billings.
Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate.
Sends initial or secondary bills to Insurance payers.
Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary.
Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager.

Requirements

What you’ll need

Able to work with advanced billing procedures.
Able to prioritize and multitask based on volume of work within specific deadlines.
Knowledge of the Revenue Cycle and the links between departments: Charge Capture, Patient Access, HIM, Coding, and Patient Financial Services.
Working knowledge involving coverage, payment, compliance, and basic billing rules for Government and Managed Care payers.
Uses discretion when discussing personnel/patient related issues that are confidential in nature.
Ability to give and follow written and verbal directions.
Working knowledge of personal computer applications and proficient in word, excel and power point applications. Self-motivator, quick thinker, communicates professionally and effectively in English, both verbally and in writing.
Ability to work with all departments and all levels of management.
One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management.
High school diploma or GED.

Benefits

Comp & perks

Adheres to all company policies and procedures.
Adheres to Optim Health Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

billing procedurescoding verificationinsurance processingclaims resolutionerror log processingmedical appealsrefund processingreinstatementsrejections of insurance claimsrevenue cycle knowledge

Soft Skills

multitaskingprioritizationdiscretioncommunicationself-motivationquick thinkingprofessionalismrelationship managementresponsibilityteam collaboration

Certifications

high school diplomaGED