Insurance Specialist

JOB SUMMARY:

Insurance Specialist is responsible for managing and collecting outstanding insurance balances owed to a healthcare provider by following up on submitted insurance claims, resolving billing discrepancies, appealing denied claims, and ensuring timely reimbursement by adhering to medical billing regulations and coding guidelines; essentially, they play a key role in the revenue cycle management of a healthcare facility by maximizing the collection of outstanding accounts receivable. Serve as a backup for Payment posting duties.

ESSENTIAL FUNCTIONS:

• Denial management: Analyzing claim denials, identifying the reason for rejection, and taking appropriate actions such as correcting coding errors, submitting appeals, or contacting the payers for clarification.
• Reporting and analysis: Generating reports on accounts receivable trends, identifying areas for improvement, and proposing strategies to optimize collection rates.
• Compliance adherence: Staying current with healthcare regulations, including HIPAA and coding guidelines (ICD-10, CPT) to ensure accurate billing practices.
• Payer communication: Contacting insurance companies to resolve billing issues, clarify claim status, and advocate for timely payment.
• Payment Posting – serve as a back-up as needed.

Minimum Job Qualifications:

Education: 2 Year / Associates Degree, preferred

License/Certifications: Billing certificate preferred

Language Skills: Ability to read and comprehend insurance, outside provider, and other short correspondence, memos, and forms; Ability to respond to outside correspondence requests in a clear, concise, and accurate manner; Ability to effectively present information in one-on-one and small group situations to providers, clients, and other employees of the organization.

Other Skills:

• Medical billing knowledge: Thorough understanding of medical billing codes (CPT, ICD-10, HCPCS) and insurance payer guidelines.
• Strong analytical skills: Ability to review complex medical records and identify potential billing errors.
• Excellent communication skills: Effective communication with patients, insurance companies, and internal stakeholders to resolve billing issues.
• Attention to detail: High level of accuracy required to ensure correct claim submission and avoid billing errors.
• Proficiency with billing software: Familiarity with electronic health records (EHR) and billing systems to submit claims electronically.