Level 2 - REMOTE BCBS Facility Claim Follow-Up Representative

Insight 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

• High school diploma or equivalent

• Outpatient hospital billing experience

• 5+ years Experience with facility claims follow-up & appeals handling

o Experience with UB04 forms

o 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 BlueCard

o 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 where denials go), Envision (SMS), Epic