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SSM Health Insurance Follow Up Specialist Lead in Bridgeton, Missouri

Insurance Follow Up Specialist - Lead

Role Purpose:

The Insurance Follow-Up Specialist is responsible for working denied claim lines and no response claims to resolve outstanding accounts and ensure timely and accurate payment. He/she is also responsible for identifying denial trends and working with his/her supervisor, manager, and team to facilitate root cause analysis and continuous process improvement.


  • Conducts timely and accurate work with the goal of resolving outstanding claims quickly and maximizing appropriate revenue.

  • Manages assigned work queues to ensure timely follow-up. Accurately deciphers denial reason and plans follow-up steps.

  • Displays sound judgment in choosing the most efficient and effective method of follow-up, including appealing denials, taking adjustments, querying payer websites, working electronic responses from payers, and/or calling payers.

  • Follows all department policies and procedures, desk level procedures, guidance documents, or other work tools designed to ensure accuracy, especially those requiring use of appropriate payment or adjustment codes.

  • Documents clear and concise notes within Epic according to established standards to facilitate resolution of outstanding claims/issues and ensure that other PRO staff are able to understand the claim history.

  • As necessary, reviews, corrects, and re-submits claims.

  • Meets established productivity and quality metrics.

  • Keeps current with payer updates and applies knowledge to assist in payment of claims.

  • Is watchful for denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.

  • Works collaboratively with other PRO departments to share feedback and ensure high functioning revenue cycle processes.

  • Performs any special assignments, as requested.

Minimum Qualifications:

  • High School diploma

  • Has knowledge of CPT-4, HCPCS, ICD-10 and medical documentation requirements.

  • Has knowledge of federal, state regulations and payer rules as they pertain to professional fee billing.

  • Possesses the ability to confer with payers by telephone to articulate information relevant to claims to ensure payment.

  • Possesses the ability to plan, organize, prioritize and effectively manage assigned workload.

  • Possesses the ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.

  • Demonstrates oral and written communication skills and ability to convey positive and professional image.

  • Has experience working in a professional billing system, preferably Epic. Possesses the ability to type/data enter information in Epic accurately and efficiently.

Preferred Qualifications:

  • Experience in professional billing insurance follow-up, Epic background and physician's billing while not required, is strongly preferred

SSM Health - System Office –

SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company. Our Mission: Through our exceptional health care services, we reveal the healing presence of God.

SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex