Insurance Specialist

Responsibilities

• Collaborate with third-party billing vendors, internal teams, and Patient Account Specialists to gather missing or corrected information required for billing, statements, and reimbursement.
• Support special projects aimed at optimizing billing workflows, maximizing reimbursement, and ensuring claims are paid timely and correctly.
• Proactively follow up on outstanding claims with vendors and internal teammates to facilitate timely payments.
• Manage insurance correspondence: process denials, apply appropriate discounts or refunds, and coordinate with Financial Counselors and Medical Records for required documentation.
• Act as a resource for Patient Account Specialists regarding insurance eligibility, coverage details, and payment discrepancies.
• Accurately post assigned payments from insurance companies, third-party funding sources, contracts, and self-pay accounts.
• Identify and communicate any insurance eligibility changes or specific denial trends to Patient Account Specialists.
• Navigate and interpret account ledgers to accurately post charges, payments, and corrections within MyAvatar.
• Utilize various healthcare websites and clearinghouses, including Waystar, Availity, WPS/GHA, KMAP, and secure SFTP portals.
• Efficiently organize, track, and work accounts, payments, and claims using Excel spreadsheets.
• Actively participate in staff meetings and collaborate with your supervisor to build a personalized professional development plan.
• Attend workshops, continuing education activities, and required in-service training to sharpen your billing expertise.
• Complete assigned training modules via the Relias Learning platform to maintain compliance and enhance your skill set.
• Maintain flexibility, accuracy, and a standard of excellence as department needs evolve, always bringing a team-oriented, cooperative attitude to the workplace.