Insurance Specialist

Insurance Specialist

The Insurance Specialist is responsible for managing insurance claims, resolving denials, and ensuring timely reimbursement by working directly with insurance payers, patients, and internal teams. This role requires strong analytical skills, attention to detail, and the ability to maintain productivity standards in a fast-paced environment.

Key Responsibilities:

• Contact insurance payers to resolve denied and unpaid claims and obtain status updates on outstanding submissions.
• Follow up on insurance claims with no payer response to ensure timely resolution and payment.
• Maintain productivity standards of 56 accounts per day while meeting quality and accuracy expectations.
• Analyze patient accounts to determine appropriate actions for balance resolution and claim correction.
• Resubmit corrected or updated claims as required to facilitate prompt reimbursement.
• Handle patient inquiries related to insurance coverage, benefits, and account status in a professional and courteous manner.
• Complete all tasks assigned by leadership, including educational initiatives and claims requiring immediate attention.
• Document all payer and patient communications accurately within the billing system.

Qualifications:

• Experience in medical billing, insurance follow-up, or revenue cycle management preferred.
• Knowledge of insurance claim processes, denials, and payer guidelines.
• Strong organizational and time-management skills with the ability to meet daily productivity goals.
• Excellent communication skills, both written and verbal.
• Proficiency in billing systems and electronic health records (EHR) preferred.

Education:

• High School Diploma or GED, required.
• Two year Associate degree, preferred.

Experience:

• Minimum two years in medical billing or hospital coding, as a claims processor, medical claims for an insurance carrier, or clerical/billing experience in a medical office, preferred.

Additional skills required:

• Excellent communication and organizational skills required.
• Ability to successfully complete generic and department specific skills validation and competency testing.
• Must display excellent customer service skills and excellent computer skills.
• Must be able to multi-task and be a team player.
• Must be able to work overtime as required.
• Must be self motivated, able to work independently without constant supervision and a critical thinker.
• Must be flexible, able to meet deadlines and adaptable to change.
• Ability to communicate effectively and professionally.
• Detail oriented and strong organizational skills.
• Aware of HIPAA laws.
• Familiar with Microsoft Office Applications.
• Must be able to manage time with tasks assigned.

Additional skills preferred:

• Basic medical terminology.
• Insurance guidelines.

Job Opening ID 143397