Insurance Follow-Up & Denials Representative
Houston, TX
Category: Healthcare
Reference ID: 10084323
Shortcut: http://addisongroup.gosnaphop.com/p7sUcF
Job title: Insurance Follow-Up & Denials Representative – Physician Billing
Location (city, state): Houston, TX
Industry: Healthcare / Revenue Cycle / Physician Billing
Pay: $21 – $23 / hour
Benefits: This position is eligible for medical, dental, vision, life insurance and 401k.
About Our Client:
Addison Group is partnering with a large healthcare organization seeking an experienced Insurance Follow-Up & Denials Representative to support professional fee collections, denials, and appeals. This opportunity is ideal for someone with strong CMS-1500 claims experience who enjoys researching complex insurance issues, resolving outstanding accounts, and maximizing reimbursement.
Job Description:
The Insurance Follow-Up & Denials Representative will manage outstanding physician insurance claims, focusing on denials, appeals, corrected claims, and reimbursement issues. This position requires strong experience with professional fee billing, payer follow-up, and the ability to independently determine the appropriate next steps to resolve accounts.
Key Responsibilities:
- Work approximately 45 physician insurance accounts per day.
- Research and resolve outstanding CMS-1500 professional fee claims, denials, and rejections.
- Perform insurance follow-up and manage accounts through resolution.
- Prepare, submit, and follow up on appeals and corrected claims.
- Investigate denials related to provider credentialing, contracting, enrollment, and out-of-network (OON) services.
- Review account history, payer responses, and supporting documentation to determine appropriate follow-up actions.
- Handle OON denials involving hospital-based physicians and emergency services.
- Review medical records and supporting documentation to substantiate appeals when necessary.
- Communicate with insurance carriers to resolve reimbursement discrepancies and outstanding balances.
- Document all account activity, payer communications, and follow-up actions accurately in Epic.
- Collaborate with internal teams to resolve complex claims and reduce outstanding A/R.
Requirements:
- Recent physician billing (profee/CMS-1500) insurance follow-up experience required.
- Strong experience with denials management, appeals, corrected claims, and rejections.
- Epic experience highly preferred.
- Experience with commercial and/or government insurance payers.
- Experience handling out-of-network denials and appeals strongly preferred.
- Knowledge of provider credentialing, contracting, and enrollment-related denials is a strong plus.
- Ability to review medical records and identify documentation supporting emergency services appeals.
- Strong understanding of payer reimbursement guidelines and insurance follow-up processes.
- High School Diploma or GED required.
Additional Details:
- Hybrid schedule – 4 days remote, 1 day onsite after training.
- First 4 weeks of training will be onsite.
- Monday–Friday, 8-hour shifts with start times as early as 7:00 AM.
- Training schedule will be assigned; additional scheduling flexibility available after training.
- Additional onsite attendance may be required for special projects or team meetings.
Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.
#HC3
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