Professional Billing: Insurance Follow-up Specialist

SUMMARYAt ZoomCare we are working hard to make healthcare easy.  Our mission is to deliver innovative, high-quality, convenient healthcare when patients need it. We offer same-day, no-wait visits in urgent care, primary care, and specialty care and we’re expanding from our roots in the Pacific Northwest to new markets.  We hope you will apply to become part of our dedicated, fast-moving team of superstars!  ZoomCare is seeking an Insurance Follow Up Specialist to join our team!  The Follow-up Specialist is responsible for resolving outstanding insurance claims to maximize reimbursement and reduce accounts receivable days. This position focuses on identifying, researching, and rectifying claim denials and delays for professional services through effective communication with insurance payers and internal departments. SCHEDULE AND TRAINING

• Monday – Friday | 9:00am-5:30pm flex schedule. 
• Depending on the position and associated requirements, there may be additional mandatory training requirements that are outside of your scheduled shift. 

ESSENTIAL FUNCTIONSReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Represent our values: Awesome, Creative, Respectful, Team Players, Get it Done.
• Work unpaid and partially paid insurance claims to resolve outstanding balances and secure accurate reimbursement in accordance with payer guidelines.
• Research claim status by utilizing insurance portals, conducting phone outreach, and drafting written correspondence as needed.
• Analyze denied or underpaid claims to identify root causes, trends, and necessary corrective actions.
• Submit timely and well-documented appeals for denied claims in alignment with specific payer policies and appeal procedures.
• Resubmit corrected claims with updated coding, documentation, or demographic information to facilitate proper adjudication.
• Maintain thorough and accurate records of all claim follow-up activities within the billing or revenue cycle management system.
• Collaborate with coding teams, clinical documentation specialists, and provider offices to gather missing information or resolve claim discrepancies.
• Monitor aging accounts and prioritize claims based on timely filing limits and payer response windows.
• Identify systemic issues or process inefficiencies impacting claim resolution and escalate concerns to management with supporting documentation.
• Meet or exceed established productivity and quality benchmarks while adhering to compliance and privacy standards.
• Other duties as assigned.

QUALIFICATIONS

• High school diploma or equivalent required; associate’s degree in healthcare administration, Business, or a related field preferred.
• 2+ years of experience in medical billing, with a focus on professional billing and accounts receivable follow-up.
• Solid understanding of CPT, HCPCS, and ICD-10 coding systems and their application in claim submission and reimbursement.
• Experience working with electronic billing systems and payer portals to manage claim status, denials, and appeals.
• Familiarity with insurance reimbursement methodologies, claim adjudication processes, and payer-specific requirements.
• Working knowledge of medical terminology and healthcare documentation.
• Strong analytical and problem-solving skills with the ability to identify issues, evaluate alternatives, and implement solutions.
• Excellent written and verbal communication skills, with the ability to collaborate effectively across teams and with external contacts.
• High attention to detail and accuracy, with proven ability to manage multiple tasks and meet deadlines in a fast-paced environment.

 COMPENSATION PACKAGE

• Medical, Dental, Vision benefits
• 401K with employer match
• Paid Time Off, Paid Holidays, Paid Parental Leave, Sabbatical Program
• Hourly Pay Rate: $23 - $29/hr
• Other Compensation: May be eligible for other compensation such as bonuses

WORKING CONDITIONS

• Project timelines and work volume/deadlines may often require more than your scheduled hours per week or work outside of regular business hours to complete essential duties of this job. 
• Ability to work at a computer/workstation for prolonged periods of time. 
• Close and distance vision and ability to adjust focus. 
• Seeing, hearing, speaking, and writing clearly to effectively communicate with others. 
• Exposure to sensitive and confidential information. 
• Occasional reaching and lifting of small objects and operating office equipment. 
• On-site presence required a minimum of 3 days per week to support non-electronic processes. Remote work available for the remaining workdays. 
• Must wear a mask as needed. 

ZoomCare is committed to the safety and wellbeing of our employees and patients. Therefore, we require thatpatient-facing employees receive all required vaccinations, including, but not limited to, Hepatitis B., MMR, PPD, Varicella (Chickenpox), TD/TDAP, and all employees to receive COVID-19 as a condition of employment. Medical and religious exemptions or reasonable accommodations may apply.