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Insurance Specialist
POSITION SUMMARY:
The Insurance Specialist is responsible for managing patient insurance processes to ensure accurate coverage verification, claims processing, reimbursement, and compliance. This role serves as a key liaison between patients, providers, and payers while supporting revenue cycle operations, resolving billing issues, and maintaining accurate insurance records.
EDUCATION AND EXPERIENCE:
- Associate degree required in Healthcare Administration, Medical Billing & Coding, Business Administration, or related field, bachelor’s degree preferred.
- Minimum of 2 years of experience in healthcare insurance, billing, or revenue cycle experience required.
- Direct experience with Medicaid billing and insurance verification is required.
- Experience with managed care, commercial insurance, provider credentialing, and denial management required.
- Must have knowledge of ICD-10/CPT coding, payer guidelines, and electronic billing systems
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Policy and Patient Support:
- Explain insurance coverage, benefits, and policy terms to patients
- Assist patients with questions regarding insurance, billing, and payment options
- Set up payment arrangements for self-pay patients and provide financial guidance
- Serve as a liaison between patients, providers, and insurance companies to resolve issues
- Verify patient eligibility, benefits, and authorization requirements prior to services
- Maintain and update patient insurance information in the electronic health record
- Ensure all providers are linked to appropriate payer contracts for accurate billing
- Support payer enrollment activities, including credentialing, re-attestation, and updates
- Maintain accurate tracking of provider enrollment status across all contracted health plans
Claims Management and Billing Support
- Review, submit, and track insurance claims to ensure timely reimbursement
- Post payments and adjustments from payers to patient accounts
- Monitor claims for errors, rejections, or delays and take corrective action
- Coordinate and process claim appeals and denial management activities
- Work credit balance accounts and ensure appropriate resolution
- Denial trend tracking and reporting
Revenue and Cycle Support
- Collaborate with insurance payors to resolve denials, underpayments, and billing discrepancies
- Identify and resolve patient billing questions and account issues
- Maintain records of billing, claims, payments, and settlements
Compliance and Regulatory Requirements
- Ensure all processes comply with HIPAA and applicable federal, state, and payer regulations
- Maintain confidentiality of patient and financial information
- Monitor payer requirements and ensure adherence to contract terms and billing guidelines
Administrative and Data Management
- Maintain accurate and up-to-date records in billing and insurance systems
- Process renewals, updates, and documentation with strong attention to detail
- Track and report on claim status, denials, and reimbursement trends
- Assist with audits by providing documentation and ensuring data accuracy
Credentialing and Payer Relations
- Assist with front-end credentialing and privileging providers and clinic locations
- Communicate with payers, underwriters, and provider offices to resolve enrollment and billing issues
- Monitor and maintain insurance contracts and payer relationships
- Ensure timely completion of credentialing and enrollment to prevent billing delays Quality and Process Improvements
- Identify trends in denials, billing errors, or delays and recommend process improvements
- Participate in workflow improvements to enhance efficiency and accuracy
- Support implementation of best practices in billing, coding, and insurance processes Core Competencies
- Knowledge of medical billing, insurance processes, and revenue cycle operations
- Understanding of payer guidelines, authorizations, and claims adjudication
- Strong attention to detail and accuracy
- Problem-solving and analytical skills
- Effective communication and customer service skills
- Ability to manage multiple priorities in a fast-paced environment
LICENSING AND OTHER REQUIREMENTS:
- Valid driver’s license and / or reliable transportation.
Starfish Family Services is an Equal Opportunity Employer
EOE/M/F/D/V
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