The Role
Follows up on complex and unpaid medical claims across Medicare, Medicaid, commercial, and specialty payors. Verifies eligibility, researches denials, submits appeals and medical records, reviews recoupments, and resolves patient billing issues. Collaborates with coding, payment posting, managed care, provider enrollment, and clinical teams to maximize reimbursement and maintain accounts receivable. Handles escalated claims, supports workflow improvements, mentors team members, and leads special projects.
Summary Generated by Built In
The Insurance Follow-up Specialist- Senior completes follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial, and Specialty insurance/program payors for a subset of multiple specialties. Analyze, screen, and update high complexity or escalated claim issues. Process appeals, write-offs, and determine if patient billing is necessary. May mentor newer team members.
Responsibilities- Initiates insurance follow-up on unresolved appealed or unpaid claims to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors, with a focus on complex insurance denials.
- Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management teams, and clinical departments.
- Assist the customer service team in resolving high-complexity and/or escalated patient billing concerns or disputes.
- Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility, or additional requests from payors.
- Analyze daily claim rejections, screen claims for pre-authorization, and request and submit medical records.
- Work closely with the team to manage high-complexity work queues and claims. Lead special projects to fruition and help define and streamline workflows.
- Meet or exceed current production standards set by the management team to resolve outstanding claims and maintain healthy accounts receivable.
- Handle requests from the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations Team to resolve claims and patient or provider issues.
- Serve as the liaison between affiliated hospitals and organizations to maximize collection efforts.
- Completes all other duties as assigned.
- Knowledge of patient billing or collection/reimbursement procedures in a healthcare setting is preferred. Experience in medical claims follow-up functions specific to processing insurance claim appeals for various payors.
- Detail-oriented, with the ability to organize, prioritize, and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
- Able to multi-task in a fast-paced, high-volume environment.
- Proficient in Microsoft Office software.
- Medical healthcare records software experience.
- Experian, Trizetto/Claim Logic experience.
Education:
- High School Diploma required
The University of Texas at San Antonio (UT San Antonio) is a nationally recognized, top-tier public research university that unites the power of higher education, biomedical discovery and healthcare within one visionary institution. As the third-largest research university in Texas and a Carnegie R1-designated institution, UT San Antonio is a model of access and excellence — advancing knowledge, social mobility and public health across South Texas and beyond. UT San Antonio serves approximately 42,000 students in 320 academic programs spanning science, engineering, medicine, health, liberal arts, AI, cybersecurity, business, education and more. With 17,000 faculty and staff, UT San Antonio has been recognized by Forbes as one of America’s Best Employers for Company Culture.
Benefits Overview
UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.
Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.
Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.
Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.
Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.
FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.
Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.
Time Off - A generous leave program offers multiple paid leave options:
- Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
- Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
- Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
- Holidays: 12 set paid holidays each year.
Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.
EEO Statement
UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.
Skills Required
- High school diploma
- Knowledge of patient billing or collection and reimbursement procedures in a healthcare setting
- Experience processing medical claim appeals for various insurance payors
- Ability to organize, prioritize, and coordinate work within schedule constraints
- Ability to handle emergent requirements in a timely manner
- Ability to multitask in a fast-paced, high-volume environment
- Proficiency with Microsoft Office software
- Experience with medical healthcare records software
- Experience with Experian
- Experience with Trizetto or Claim Logic
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The Company
What We Do
UT Health San Antonio™, one of the country’s leading health sciences universities, is the leader in south/central Texas funding for the National Institutes of Health (NIH). The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 33,000 alumni. The $806.6 million operating budget supports four campuses in San Antonio and Laredo, and is the primary driver of its community’s $37 billion biomedical and health care industry. For more information on the many ways “We make lives better®,” visit uthealthsa.org.
