The Cerner Commercial Follow Up Specialist (UB-04) is responsible for managing and resolving outstanding inpatient hospital claims to ensure accurate and timely reimbursement. This role serves as a liaison between hospitals, clinics, insurance payers, and internal revenue cycle teams. The specialist conducts detailed follow-up on unpaid, underpaid, denied, or rejected claims, ensuring proper documentation, correction, and resubmission when necessary.
The ideal candidate is highly detail-oriented, organized, and capable of working in a fast-paced healthcare revenue cycle environment while maintaining strong communication with payers and internal stakeholders.
Key Responsibilities
- Perform follow-up on outstanding UB-04 (inpatient) claims with commercial and government payers.
- Research and resolve denied, rejected, zero-paid, or underpaid claims.
- Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to determine next steps.
- Post denials to patient accounts using accurate denial reason codes and appropriate CAS codes.
- File claim corrections and submit appeals to insurance carriers to secure maximum reimbursement.
- Identify billing errors and coordinate corrections prior to resubmission.
- Document all follow-up actions, payer communications, and account activity thoroughly in the system.
- Communicate with insurance representatives to verify claim status, request reconsiderations, and escalate unresolved issues.
- Maintain daily productivity and quality assurance standards as outlined by management.
- Assist with backlog projects, including credit balance resolution, unapplied payments research, and account reconciliation.
- Serve as a resource to team members regarding payer policies, denial trends, and follow-up strategies.
- Participate in team projects and continuous process improvement initiatives.
- Maintain confidentiality and protect patient health information in compliance with HIPAA and other regulatory standards.
- Stay updated on payer guidelines, reimbursement policies, and regulatory changes.
Required Qualifications
- 1–3 years of hospital claims processing or insurance follow-up experience.
- Hands-on experience working with Cerner for UB-04 (inpatient) claims.
- Strong understanding of denial management and appeals processes.
- Working knowledge of CPT, ICD-10 coding, and medical terminology.
- Experience communicating with commercial and government payers.
- Understanding of CAS codes and remittance advice interpretation.
- Proficiency with computer systems and revenue cycle software.
- Strong written and verbal communication skills.
- Ability to multitask, prioritize workload, and meet productivity standards.
- Responsible handling of confidential patient information.
Preferred Qualifications
- Experience in hospital revenue cycle or accounts receivable follow-up.
- Ability to work with high-profile clients and complex payer processes.
- Strong analytical and problem-solving skills.
- Flexible and adaptable in a dynamic work environment.
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