Insurance Analyst

The SSI Group, LLC, headquartered in Mobile, Alabama, is a national leader in Healthcare Technology.

Insurance Analyst

Job Code

IA.124.001

FLSA Status

Non Exempt

Job Family

Riverchase Billing

Cost Center

124

Purpose of Position

Responsible for managing medical insurance claims, billing processes, and data entry to ensure accurate reimbursement, compliance with healthcare regulations, and resolution of claim discrepancies. This role involves submitting claims, handling denials, verifying patient insurance, and maintaining accurate records.

Duties and Responsibilities

Essential Functions

• Process, review and submit insurance claims to third-party payers (Medicare, Medicaid, private insurers) based on medical coding, billing data, and patient insurance information.
• Ensure that claims are complete, accurate, and compliant with payer-specific rules and guidelines.
• Investigate and analyze denied claims, identifying the cause of denials (e.g., coding errors, missing documentation, eligibility issues).
• Work with coding and clinical teams to resolve issues and resubmit claims for payment.
• Appeal denied claims and work to ensure that payments are received promptly.
• Review insurance company remittance advice (EOBs) to confirm payments are consistent with the terms of the payer contract.
• Resolve discrepancies between billed amounts and paid amounts, ensuring accurate adjustments and patient responsibility.
• Communicate with payers to resolve any outstanding payment issues.
• Ensure proper verification of patient insurance eligibility and benefits prior to service delivery.
• Confirm that required pre-authorizations or referrals are obtained for specific procedures, treatments, or hospital admissions.
• Track and report on key performance indicators (KPIs) related to claims processing, such as claim approval rates, denials, and aged accounts.
• Generate reports to identify trends in claims issues, payer performance, and payment delays.
• Post insurance and patient payments accurately into billing systems and reconcile transactions to ensure proper allocation.
• Stay up-to-date with changes in healthcare regulations, payer policies, and billing codes (ICD-10, CPT, HCPCS).
• Ensure that the department remains compliant with federal, state, and payer-specific billing requirements, including HIPAA.
• Assist patients and other stakeholders with insurance-related inquiries, helping to explain coverage issues, billing questions, or denials.

Marginal Functions

Skills, Knowledge, and Abilities

Information Security and Data Protection

The SSI Security-First Mindset

Information security and data protection is a shared responsibility - codified in our commitment to the SSI Security-First Mindset. The SSI Security-First Mindset is comprised of five pillars and universally applicable to all employees, regardless of position description, assigned duties and responsibilities.

The Five Pillars of the SSI Security-First Mindset :

Experience and Education Requirements

Education

Min / Preferred

Education Level

Description

Minimum

High School or GED

High school diploma or equivalent required.

Preferred

2 Year / Associate Degree

Associate's degree in Healthcare Administration, Business, or a related field preferred.

Years of Experience

Minimum Years of Experience

Comments

2+ years of experience with medical billing required.

Credentialing experience a plus.

Certifications

Min / Preferred

Certification

Description

A combination of experience and advanced education may be substituted. Background checks and drug test required.

Acknowledgement

I have read and understand this job description and agree that I am able to fulfill the essential functions as stated above. I further understand that it is my responsibility to request an accommodation, if necessary, to fulfill the essential functions of this position.

Employee's Signature

Date

Supervisor Signature

Date

SSI offers competitive salaries and an excellent benefits package including medical, dental, life / AD&D, LTD, vision, 401(k) matching, paid vacation and tuition reimbursement.