Insurance Specialist 3

Location: Remote within US Only – must work in Hawaii Time Zone.

Schedule

Monday – Friday, 7:30 AM – 4:00 PM (Hawaii Time Zone).

Responsibilities

• Resolve complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF), or intermediate care facility (ICF) claims.
• Prepare and submit claims to Medicare, Medicaid, and private insurers; ensure compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements); verify coverage and eligibility; resolve claim denials or discrepancies.
• Coordinate with clinical, admissions, and finance teams to ensure accurate documentation, maintain patient billing records, and optimize reimbursement through proper coding and timely claim submission.
• Apply knowledge of LTC billing systems, reimbursement models, and payer guidelines.
• Identify and report trends found during the account resolution process, such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, or no claim on file.
• Perform financial account assessment functions, including adjustments and determining balance to patient.
• Work within client systems to complete rebill functions.
• Perform administrative functions, including medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests, approve for client assistance or correct the bill within client platform, and review/submit payment verification assistance requests.
• Maintain familiarity with client preferences and known issues across multiple client accounts.
• Support special projects for clients as needed.
• Other duties as assigned.

Requirements

• High School Diploma or equivalent.
• 5+ years of relevant industry experience in registration, billing, or collections.
• 3+ years of experience with LTC and/or SNF claims resolution.
• Knowledge of UB-04 claim forms, EOBs, and medical records.
• ICD-9, ICD-10, CPT, and HCPCS coding knowledge.
• Ability to conduct detailed research to resolve complex claims.
• Intermediate mathematics skills (addition, subtraction, ability to identify trends, etc.).
• Ability to compile and summarize data.
• Strong verbal and written communication skills.
• Ability to analyze and interpret complex documents, contracts, notes, and other correspondence.
• Ability to prioritize and multitask in a fast-paced environment.
• Ability to work effectively in a remote environment.
• Investigative mindset to identify issues and implement solutions.

Benefits

• Competitive hourly salary.
• Medical, dental, and vision insurance.
• Equipment provided.
• 401k program.
• Accrued PTO – 80 hours annually.
• Paid paternity and maternity leave programs.
• 9 paid annual holidays.
• Tuition reimbursement.
• Professional growth opportunities.