Claims Follow-Up Analyst
- Conduct timely follow-up on submitted behavioral health claims (commercial, Medicaid, Medicare).
- Research and resolve unpaid, underpaid, delayed, or denied claims.
- Identify root causes of denials and take corrective action to prevent recurrence.
- Submit corrected claims, reconsiderations, and formal appeals as required.
- Track and monitor appeal timelines and outcomes.
- Communicate directly with insurance payers via phone, portals, and written correspondence.
- Obtain claim status updates, clarification on denials, and payment determinations.
- Document all payer interactions thoroughly in the billing system.
- Verify that services billed align with authorizations, level of care, and medical necessity.
- Collaborate with clinical and authorization teams to obtain missing documentation.
- Identify authorization-related denials and escalate trends to leadership.
- Maintain assigned accounts receivable (A/R) work queues and meet productivity standards.
- Prioritize high-dollar, aged, and high-risk claims.
- Support month-end and audit readiness activities.
- Identify payer trends and recommend process improvements.
- Ensure all activities comply with HIPAA, payer contracts, and state/federal regulations.
- Maintain accurate, complete documentation to support billing and audit requirements.
- Follow internal policies and revenue cycle procedures.
- High school diploma or equivalent required; associate or bachelor’s degree preferred.
- Minimum 2 years of claims follow-up or A/R experience, preferably in behavioral health.
- Working knowledge of:
- CPT/HCPCS and ICD-10 coding basics
- Behavioral health levels of care (OP, IOP, PHP, residential, MAT, etc.)
- Medicaid, Medicare, and commercial payer processes
- Strong understanding of EOBs, remittances, and denial codes.
- Proficiency with EHRs, practice management systems, and payer portals.
- Excellent written and verbal communication skills.
- Experience with Ohio Medicaid and managed care plans (if applicable).
- Knowledge of behavioral health authorization and medical necessity criteria.
- Prior appeals and reconsideration experience.
- Revenue cycle certification (CRCR, CPC, CPB, or similar).
- Analytical and detail-oriented
- Strong follow-through and persistence
- Time management and prioritization
- Problem-solving mindset
- Professional communication with payers and internal teams
- Ability to work independently and as part of a team
- Primarily sedentary office or remote work.
- Prolonged computer and telephone use.
- Occasional deadlines requiring focused attention.
Recommended Jobs
Tarper/Jockey Driver
Position requires driving an Ottawa and/or Capacity "jockey/spotter" truck to move trailers around the property, into & out of loading/unloading area, and to help with tarping operation as needed. Ex…
Client Experience Associate
R209826 Job Profile Position Overview At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience …
Registered Nurse (RN) - PACU - St. Rita's Medical Center
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and op…
Advanced CNC Machinist
Location: Mansfield, OH Job Type: Full-Time | 1st Shift. Applicants must be currently authorized to work in the United States on a full-time basis. The employer will not sponsor applicants for wor…
Training Manager
At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. Position Summary The Trai…
Assembler/Packaging Associate
SUMMARY Responsible for working on the production line as assigned. Maintain a safe, well organized workplace. Must possess strong organization skills and attention to details. ESSENTIAL DUTIES AND …
Senior Tax Associate
Rea is a growing Top 100 business advisory & accounting firm providing our clients services in tax, accounting, and business consulting. We have a ‘People First’ culture and we focus on our employ…
Night Auditor - Part Time
Job Title: Night Auditor Reports To: General Manager FLSA Status: Non-Exempt Summary: The Night Auditor is responsible for checking guests into the hotel while reconciling the previous d…
Overnight Operations Supervisor (Hiring Immediately)
Production Supervisor - 3rd Shift The Land O’Lakes Supply Chain & Operations division provides strategic leadership across the company’s many business units. The team plays a significant role in fu…
Occupational Therapy Assistant / COTA / OTA
Occupational Therapy Assistant / COTA / OTA Broad River Rehab is seeking an Occupational Therapy Assistant to join our Cincinnati, OH (45206) Skilled Nursing Facility. Full-Time, Flexible Schedu…