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Role Description

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.

• 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.

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.