Medical Insurance Specialist

About the role

The Medical Insurance Specialist independently submits or takes the necessary actions to resolve rejected or denied insurance claims by performing all collection tasks as assigned utilizing collection processes with a high level of knowledge, skills, abilities, and experience. The follow-up position will assume duties as a collector/denial specialist, to manage patient accounts receivable from the point of resubmission of rejected or denied medical claims through final resolution. Identify and address denials by writing appeal letters and ensure account balances are correct based on payer contract terms.

Responsibilities

• Conduct follow-up on unpaid or denied claims to ensure timely and accurate reimbursement.
• Analyze denial reasons and take appropriate action to appeal or resubmit claims.
• Contact payers and utilize online portals to resolve outstanding account balances.
• Collaborate with billing, coding and clinical staff to gather necessary documentation for appeals or corrections.
• Track and document follow-up activities in Epic.
• Quickly identify and solve problems, escalating recurring denial trends or payer issues to reimbursement coding specialist when necessary.
• Responsible to validate the payments and adjustments made on accounts are correct.
• Maintains daily work queues.
• Acts as a liaison between insurance and providers to ensure coverage and benefits are active at the time of billing.
• Identify authorization numbers saved in the system and attach them to our claims as needed for processing.
• Assist with training and continuous education for billing staff to ensure adherence to ethical billing practices.
• Perform other related duties as assigned, including supporting process improvements and serving as a technical resource and duties that are consistent with the lower level of the medical insurance series.

Requirements

Any one or combination totaling two (2) years (24 months), from the categories below: College coursework in a health-related field, business administration/management, human resource management, or closely related fields, as measured by the following conversion table or its proportional equivalent:30 semester hours equals one (1) year (12 months)Associate’s Degree (60 semester hours) equals eighteen months (18 months)90 semester hours equals two (2) years (24 months)

Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.

Qualifications

Minimum qualifications include:

• Associate’s Degree (60 semester hours) or higher
• Two (2) years (24 months) of relevant work experience

Skills

Knowledge of medical billing and coding procedures, familiarity with electronic health records (EHR) systems, excellent communication and problem-solving skills, ability to work independently and under pressure, and proficiency in Microsoft Office applications.

Benefits

This position is eligible for benefits, which include Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid Time Off, and Tuition waivers for employees and dependents.

Pay

$22.48 - $23.86 per hour, commensurate with experience.

Schedule

Days, Monday through Friday, 8 a.m. - 4:30 p.m.