Revenue Cycle Follow-Up Representative

About the Role Role Description: The Revenue Cycle Follow-Up Representative is responsible for ensuring timely and accurate follow-up on both Professional Billing (PB/CMS-1500) and/or Hospital Billing (HB/UB-04) claims. This role manages accounts receivable, resolves unpaid and underpaid claims, and drives 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 calls, 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.
• Appeals & Reconsiderations: 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 for Medicare, Medicaid, and commercial payers.
• Payer & System Knowledge: 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.
• Utilize resources provided by the client to promote accuracy and resolve claims in accordance with client expectations.
• Compliance & Documentation: Ensure accurate and detailed documentation of all follow-up activities in Epic. Communicate with insurance companies, patients, and internal teams to resolve claims and promote cash collections.
• Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies. Always maintain confidentiality of patient and account information (HIPAA).
• Adhere to prescribed policies and procedures outlined in the Employee Handbook and Code of Conduct. Maintain awareness of and actively participate in the Corporate Compliance Program.
• Maintain a confidential and orderly remote work area. Meet specified goals and objectives assigned by management and/or the Client. Assist with other projects as assigned by management. What We're Looking For
• Strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements.
• Experience managing PB (CMS-1500) and HB (UB-04) claims and working with Epic.
• Proficiency with payer portals (Availity, NaviMedix, Arkansas DHS portal) and review of 835 remittance/ERA data.
• Ability to analyze account history in Epic and identify payer trends and discrepancies.
• Excellent communication with insurance companies, patients, and internal teams; ability to escalate and resolve issues.
• Knowledge of Medicare, Medicaid, and commercial payer-specific appeal deadlines and formatting.
• HIPAA-compliant, meticulous documentation and adherence to policies. Nice to Have
• Prior experience with claim corrections, rebilling, and resubmissions.
• Familiarity with Epic work queues and remote work environment.
• Knowledge of AR metrics (e.g., AR days, cash collections) and productivity targets. Compensation & Benefits
• Not specified in posting.