Revenue Cycle Follow-Up Representative

Job title: Revenue Cycle Follow-Up Representative

About the Role The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on PB (CMS-1500) and HB (UB-04) claims, managing accounts receivable, resolving unpaid and underpaid claims, and driving reimbursement from government and commercial payers. The ideal candidate has strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.

What You'll Do

• Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims via phone, payer websites, and Epic work queues to ensure timely reimbursement.
• Investigate and resolve unpaid, underpaid, and rejected claims by working with insurance providers and internal departments.
• Analyze account history and all previous actions in Epic prior to taking the next action step to resolve the claim.
• Identify payer trends and payment discrepancies across both PB and HB claim types and escalate findings to leadership.
• Understand when claim corrections, rebilling (837P or 837I), and resubmissions are applicable.
• Escalate claims with payers for resolution on inaccurate or delayed claim processing.
• Submit reconsiderations and/or appeals for both PB and HB claims with appropriate attachments, documentation, and clinical justification; adhere to payer-specific appeal deadlines and formatting requirements.
• Navigate Epic to manage HB and PB work queues, document follow-up activity, and review 835 remittance/ERA data.
• Utilize payer portals (Availity, NaviMedix, Arkansas DHS portal, and others) to verify claim status and obtain EOBs.
• Ensure accurate and detailed documentation of all follow-up activities in Epic; maintain confidentiality of patient information (HIPAA) and promote cash collections.
• Adhere to regulatory and client-specific policies; maintain a confidential and orderly remote work area; participate in Corporate Compliance Program.
• Meet defined goals and objectives (e.g., CSAT, quality scores, AR days, cash collected, productivity) and support other projects as assigned.

What We're Looking For

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred.
• 2+ years of experience in healthcare revenue cycle, claims processing, or AR follow-up; experience with PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up.
• Prior experience with Epic billing and/or follow-up work queues strongly preferred.
• Familiarity with Medicaid, Medicare, and commercial payers; ability to read and interpret 835 ERA / EOB remittance data.
• Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes; proficiency with Epic modules and work queues.
• Ability to interpret CARC/RARC denial and adjustment reason codes; familiarity with payer portals (Availity, Arkansas DHS, and commercial payer sites).
• Excellent communication with payers, patients, colleagues, and management; self-motivated, organized, and able to manage multiple tasks with minimal supervision.

Nice to Have

• Epic billing/follow-up experience strongly preferred (if not already listed above).
• Additional experience with 835 remittance data interpretation and Medicare/Medicaid specifics.

Compensation & Benefits

• Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.