REMOTE Inpatient Facility Claim and Denial Representative

Day to Day:
Insight Global is looking for Inpatient Insurance Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. The Insurance Follow-Up Representative is responsible for managing post-billing insurance claim activity for non-government payers across three acute hospitals in Washington DC. This team focuses on facility claims only, and this role is focused only on inpatient claims follow up. 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 inpatient hospital claims after billing, especially those that are denied or underpaid.
• Review EOBs and contracts to 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.
• Utilize payer portals to follow up and resolve outstanding claim issues.
Payer Interaction:
• Handle all commercial payers including Aetna, Blue Cross, UnitedHealthcare, Cigna, and Medicare Advantage plans.
• Understand and navigate multiple contracts per payer.
Analytical Review:
• Differentiate between pricing errors vs. payment errors.
• Accurately price claims based on contract terms and identify variances.
Scope of Work:
• Inpatient facility claims ONLY
• Technical denials ONLY

We are a company committed to creating diverse and inclusive environments where 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 HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

• High school diploma or equivalent
• INPATIENT!!! Hospital billing experience
• Experience with UB04 forms
• Experience with insurance claims follow-up & appeals handling
o Knowledge of DRG codes (used only in inpatient billing)
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 commercial payers (UHC, Aetna, Cigna, BCBS, Medicare Advantage Plans, etc.)
o Experience using payer portals
• Strong experience reading and interpreting payer contracts (especially outside Maryland).
o Must understand that payers like United may have multiple contract variations (e.g., 7 different contracts).
• Knowledgeable of ICD + CPT Codes
• Experience meeting a productivity standard of following up on ~55 claims per day.
• 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

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.