Insurance Claim Follow-Up Representative\nJob DescriptionInsight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area.

This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues-not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).

Primary Responsibilities:

Claims Management

Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid
Determine what was paid, what was denied, and why
Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc.

Payer Interaction

Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard
Understand and navigate multiple contracts
Utilize BCBS portal to follow up and resolve outstanding claim issues.

Analytical Review

Differentiate between pricing errors vs. payment errors
Accurately price claims based on contract terms and identify variances.

Scope of Work

Outpatient facility claims ONLY
Technical denials ONLYWe are a company committed to creating diverse and inclusive environments w people can bring their full, authentic selves to work every day.

We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HRinsightglobal.

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insightglobal/workforce-privacy-policy/.Skills and Requirements

High school diploma or equivalent
Outpatient hospital billing experience
5+ years Experience with facility claims follow-up & appeals handlingo Experience with UB04 formso This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.
Strong experience working with BlueCross BlueShield CareFirst and/or BlueCardo Familiarity using payer portal, their escalation process, how to read and interpret contracts
Experience meeting a productivity standard of following up on ~80 claims per day with 98% accuracy
Knowledgeable of

ICD + CPT

Codes

Attention to

Detail:

o Must be able to spot errors and inconsistencies in claims and contracts

Analytical Thinking:
o Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly
Independent & Fast Learner
Tech Savvy (Excel, Teams, etc.) and experience working fully remotely
Experience with systems: Med-Connect for medical records, RCI (repository w denials go), Envision (SMS), Epic

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