Insurance Specialist

Job Description

REQUIREMENTS

• High School diploma or GED
• Previous health insurance billing experience
• Working knowledge of medical terminology
• Strong problem-solving skills and the ability to adapt to changes in policies, regulations, and procedures
• Excellent written and verbal communication skills
• High attention to detail
• Ability to interact effectively with others
• Ability to maintain confidentiality
• Proficient computer skills with knowledge of Microsoft Word and Excel

RESPONSIBILITIES

• Follow up on claim status via insurance portals or calls to payers to determine adjudication and details.
• Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage.
• Verify patient insurance eligibility and coordination of benefits.
• Review and analyze payer correspondence.
• Investigate electronic claim rejections.
• Submit claims for processing corrections, to secondary insurances, or to updated addresses.
• Research requests for insurance payment retractions.
• Monitor and notify management of payer trends and/or claim processing issues.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

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