health insurance specialist

Prosper Infusion

<div><p><b>Delivering personalized, in-home care to patients with rare diseases across Florida.</b></p><h3 class="jobSectionHeader"><b>
About Prosper Infusion</b></h3><p>
Prosper Infusion is a specialized home infusion pharmacy focused on bringing high-quality therapies directly to patients&mdash;removing the burden of traveling to infusion centers and elevating the standard of care through a concierge-level experience.</p><p></p><h3 class="jobSectionHeader"><b>
Role: Health Insurance Claims Specialist</b></h3><p>
This position reports to the Billing Manager and is essential to ensuring our services are reimbursed accurately. Insurance companies frequently deny or underpay claims&mdash;your role is to dig into the details, challenge discrepancies, and drive appropriate payment.</p><p></p><h3 class="jobSectionHeader"><b>
Location: Largo Satellite Office</b></h3><ul><li><p><b>
On-site only</b> (Monday&ndash;Friday, 8:30 AM &ndash; 5:00 PM)</p></li><li><p>
Must be comfortable working independently, including times when you may be the only team member in the office</p></li><li><p>
If you&rsquo;re seeking a remote role, this position will not be a fit</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
What You&rsquo;ll Do</b></h3><ul><li><p>
Contact insurance companies to investigate denied or underpaid claims and work toward resolution</p></li><li><p>
Track and manage a pipeline of claims, ensuring all required documentation is complete and up to date</p></li><li><p>
Partner with internal teams to support patient care and resolve billing issues efficiently</p></li><li><p>
Communicate professionally and confidently with insurance representatives and team members</p></li><li><p>
Take ownership of claim outcomes, including escalating issues when needed</p></li><li><p>
Ask questions and think critically to uncover the root cause of payment issues</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
Qualifications</b></h3><ul><li><p>
Bachelor&rsquo;s degree preferred, but not required</p></li><li><p>
At least 1 year of experience in healthcare or an office-based role</p></li><li><p>
Strong verbal and written communication skills</p></li><li><p>
Excellent organizational and time-management abilities</p></li><li><p>
Detail-oriented with strong problem-solving skills</p></li><li><p>
Ability to manage multiple priorities and follow up consistently</p></li></ul><p></p><h3 class="jobSectionHeader"><b>
Who You Are</b></h3><p>
You&rsquo;re persistent, resourceful, and comfortable pushing for answers. You don&rsquo;t accept vague responses, and you&rsquo;re confident navigating conversations with insurance companies to get results. You take ownership of your work and thrive in a role where follow-through and accountability matter.</p><p>
</p><p>SMGQmuEcvT</p></div>

Health Insurance Claims Specialist - Largo

Blue Fish Pediatrics

<p>We are currently looking for a full-time (35-40 hrs/week) Insurance Verification Specialist. This person is responsible for verifying and recording up-to-date health insurance benefits for patients in our EMR software. This employee will be based at our Cypress office, which is located at 9530 Huffmeister Rd.</p><p>An ideal candidate for this position will possess the following qualities:</p><p>- Quick-learner</p><p>- Detail-oriented</p><p>- Accurate</p><p>- Types 50+ WPM</p><p>Previous experience in a similar role at a medical practice is preferred but not required. Working knowledge of eClinical Works is a plus</p><p>Please do not call our office directly as only those candidates who apply via Indeed will be considered.</p><p>Job Type: Full-time</p><p>Pay: $14.00 - $17.00 per hour</p><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Education:</p><ul><li>High school or equivalent (Required)</li></ul><p>Work Location: In person</p>

Insurance Verification Specialist

Renown Health

<div><div><div><div><div><div><div><div><div><p><b>Position Purpose</b></p><br>
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<div><div><div><div><div><div><div><div><div><div><p>The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.</p><br>
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</div></div><p></p><div><div><div><div><p><b>Nature and Scope</b></p><br>
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<div><div><div><div><div><div><div><div><div><div><p>The Insurance and Claims Specialist is responsible for:</p><br>
<p></p><ul><li>Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.</li></ul>
<ul><li>Audit denials and payment variances to determine root cause and correction as required.
</li></ul><ul><li>Auditing payment variances ensuring appropriate reimbursement.</li></ul>
<ul><li>Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.</li></ul>
<ul><li>Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.
</li></ul><ul><li>Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.</li></ul>
<ul><li>Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.</li></ul><br>
<p></p><p>This position is required to operate within policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with Renown Health goals and objectives.</p><br>
<p></p><p>This position does not provide patient care.<br>
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<div><div><div><div><div><div><p><b>Disclaimer</b></p><br>
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<div><div><div><div><div><div><p>The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.</p><br>
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</div></div><p></p><div><div><div><div><p><b>Minimum Qualifications</b><br>
Requirements - Required and/or Preferred</p><br>
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<div><div><div><div><div><div><div><div><div><div><p><b>Name</b></p><br>
</div><div><p><b>Description</b></p><br>
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<div><div><p>Education:</p><br>
</div><div><p>Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.</p><br>
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<div><div><p>Experience:</p><br>
</div><div><p>One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.</p><br>
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<div><div><p>License(s):</p><br>
</div><div><p>None.</p><br>
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<div><div><p>Certification(s):</p><br>
</div><div><p>None.</p><br>
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<div><div><p>Computer / Typing:</p><br>
</div><div><p>Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.</p><br>
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<p></p>Location: Renown Health &middot; 100620 Hospital Billing Services<br>
Schedule: Full Time - Eligible for Benefits, Day, 8am-4:30pm</div>

Insurance and Claims Specialist - Hybrid

Beacon Health System

<div><div><div><div><div><div><p>Beacon Health System is hiring <b>a full-time day Patient Access Insurance </b><b>Specialist</b>, in our <b>Verification of Benefits</b> <b>Department</b> at <b>Beacon Health System</b> in South Bend, IN.<br>
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<b>Be a Beacon. Make a Difference.</b></p>
<p>At Beacon Health System, you&rsquo;re not just part of a team, you&rsquo;re part of something bigger. Every patient interaction is a chance to lead with compassion, build trust, and create lasting impact. Here, your expertise supports healing, and your heart connects us to the communities we serve.</p>
<ul><li>Medical, Dental, &amp; Vision Insurance through Cigna</li>
</ul><ul><li>Life Insurance</li>
</ul><ul><li>403(b) Matching Retirement Fund</li>
</ul><ul><li>Competitive Paid Time Off (PTO)</li>
</ul><ul><li>Shift Differentials</li>
</ul><ul><li>Employee Assistance Program (EAP)</li>
</ul><ul><li>Tuition and Certification Reimbursement</li>
</ul><ul><li>Clinical Ladder Program</li>
</ul><ul><li>Local and National Discounts</li>
</ul><ul><li>Beacon Academy Educational Courses</li>
</ul><ul><li>Gym Membership Discount</li>
</ul>
<p><b>About Beacon Health System</b></p>
<p>Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.</p>
<p><b>What You&rsquo;ll Do</b></p>
<p>As a Patient Access Insurance Specialist, you will report to the Patient Access Director or the Insurance Specialist Supervisor. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider. The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures. They will work closely with medical staff, clinical staff, referring clinics, Beacon Outpatient Scheduling Surgery Scheduling, Social Services, and Utilization Review departments. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring authorization, pre-certification, and prior approval for admissions to Beacon or Epworth Center by using web-based tools, other electronic means where possible, or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Utilization Review, Social Services, Beacon Outpatient Scheduling and Surgery Scheduling departments. Performs other clerical duties as necessary.</p>
<p><b>Patient Access Insurance Specialist</b> <b>Job Responsibilities:</b></p>
<ul><li>Verify and update patient demographic and financial information to ensure accuracy in the registration system.</li>
<li>Obtain and validate insurance coverage using online eligibility systems, payer portals, and telephone verification.</li>
<li>Utilize Cerner systems and reports (e.g., PHS, SurgiNet, Medical Necessity Checker) to review scheduled patients, procedures, and medical necessity requirements.</li>
<li>Audit and complete required documentation, including MSP questionnaires and insurance verification records.</li>
<li>Coordinate verification of benefits (VOB) by confirming co-pays, deductibles, coinsurance, out-of-pocket limits, and rehabilitation benefits with insurance providers.</li>
<li>Secure and document pre-authorizations and pre-certifications for ancillary, surgical, outpatient, and inpatient procedures.</li>
<li>Collaborate with physician offices, scheduling teams, and referring facilities to ensure required authorizations are obtained and procedures are properly scheduled.</li>
<li>Validate CPT and ICD-10 codes and confirm compliance with Medicare Inpatient Only Procedure (MIPO) requirements when applicable.</li>
<li>Identify out-of-network insurance plans and follow established policies and procedures.</li>
<li>Refer patients to Financial Counselors or Eligibility Specialists when financial clearance or payment arrangements are required.</li>
<li>Maintain accurate worklists, documentation, and records to support timely claim submission and reimbursement.</li>
<li>Calculate and communicate estimated patient financial responsibility, including co-payments and coinsurance.</li>
<li>Prepare reports, patient statistics, and documentation to support departmental operations and leadership requests.</li>
<li>Provide professional customer service by answering calls, communicating with patients and internal departments, and maintaining positive patient relations.</li>
<li>Collaborate with departments such as Utilization Review, Surgery Scheduling, Social Services, and Outpatient Scheduling to ensure accurate and timely patient processing.</li>
<li>Support departmental quality goals by maintaining productivity, accuracy, and compliance with Beacon policies and procedures.</li>
<li>Maintain professionalism while representing Beacon Health System and perform other duties as assigned.</li>
</ul>
<p><b>What You Bring</b></p>
<p>As a Patient Access Insurance Specialist, it requires strong office and computer skills, including keyboarding (minimum 40 wpm), data entry, and proficiency with systems such as Cerner, Pathways Healthcare Scheduling, Experian, and MCA Compliance Checker. Demonstrates knowledge of medical terminology, insurance coverage, managed care networks, ICD-10 and CPT codes, and time-of-service collections, including the ability to clearly communicate financial responsibilities to patients. You will possess strong telephone, verbal communication, and listening skills to effectively interact with patients, insurance companies, physicians, and internal departments. You will maintains professionalism and sensitivity when working with diverse populations, follows strict confidentiality policies, exercises sound judgment in stressful situations, and applies basic math skills to calculate patient financial responsibilities such as deductibles, coinsurance, and out-of-pocket costs.</p>
<p><b>Required Qualifications</b></p>
<ul><li>The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent).
</li><li>A minimum of two years of experience in a hospital or physician practice business office is required.
</li><li>Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required.</li>
<li>A medical terminology course must be successfully completed prior to employment.
</li><li>Associate's degree preferred.
</li><li>Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.</li>
</ul>
<p><b>The Beacon Way</b></p>
<p>At Beacon Health System, our approach to care goes beyond clinical excellence because it&rsquo;s built on meaningful connections. Guided by our core values of Trust, Respect, Integrity, and Compassion, we strive to create an environment where patients feel heard, employees feel valued, and innovation thrives.</p>
<p>We call this commitment The Beacon Way&mdash;a six-point operating system that empowers every team member to lead with purpose, communicate clearly, cultivate talent, embrace performance improvement, leverage innovation, and build greatness through accountability. Whether at the bedside or behind the scenes, everyone at Beacon plays a role in moving health forward.</p></div><br>
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Location: Beacon Health System &middot; Verification of Benefits<br>
Schedule: Full-time, Day, 0830-5pm M-F</div>

Patient Access Insurance Specialist, Verification of Benefits Department, Full-Time Days

Precise Behavioral INC.

<p><b>Precise Behavioral </b>is hiring!</p><p>We are seeking a detail-oriented Payor Enrollment Specialist to join our team. The Payor Enrollment Specialist is responsible for end-to-end provider enrollment across multiple states for a behavioral health medical group. This includes psychiatrists, psychiatric NPs, therapists (LCSW), and other licensed clinicians delivering behavioral health services, both via telemedicine across state lines, and onsite services.</p><p><b>Precise Behavioral (Precise)</b> was established to revolutionize the behavioral healthcare ecosystem for patients, providers, and health plans. Precise is a physician-owned and led organization that enables a mix of digital, telehealth, in-person, and community resources for improved patient outcomes.</p><p><b>Scope of service:</b> This role ensures rapid provider onboarding, compliance with state and federal regulations, and timely reimbursement by managing enrollments with commercial payors, Medicare, and Medicaid (including telehealth-specific requirements).</p><p><b>Schedule</b>: Monday through Friday 8am-5pm</p><p><b>Key Responsibilities:</b></p><ul><li>Manage enrollment for Psychiatrists (MD/DO), Psychiatric Nurse Practitioners (PMHNP), Therapists (LCSW, Psychologists).</li><li>Execute multi-state enrollments across commercial plans (e.g., national carriers, Blues plans, regional MCOs), Medicare (including telehealth billing eligibility), Medicaid and Medicaid Managed Care Organizations (MCOs).</li><li>Handle state-specific supervision/collaboration requirements (e.g., NP collaborative agreements where applicable).</li><li>Ensure providers are enrolled correctly for Place of Service (POS 02 &amp; 10), and Telehealth modifiers (e.g., 95, GT as required).</li><li>Understand and manage cross-state licensure implications for telehealth delivery, payor-specific telehealth policies (varies widely by state and plan), validate that enrollments align with virtual care billing rules to prevent denials.</li><li>Medicare &amp; Medicaid Specialization Medicare enrollment via PECOS (CMS-855I/B/R forms), and multi-state Medicaid enrollments (high variability across states).</li><li>Responsible for tracking revalidations, site/service location updates (critical for telehealth orgs).</li><li>Navigate Medicaid nuances such as behavioral health carve-outs, state-specific tele-mental health rules.</li><li>Commercial Payor Enrollment (Behavioral Health Focus), National carriers (e.g., UnitedHealthcare, Aetna, Cigna), Blues plans (state-specific), Behavioral health carve-outs (e.g., Optum Behavioral, Magellan).</li><li>Understand differences between facility vs. individual enrollment, group vs. solo provider enrollment, track delegated vs. non-delegated arrangements.</li><li>Partner with Recruiting &amp; Clinical Ops to align enrollment timelines with provider start dates, reduce days to first billable appointment, revenue leakage from enrollment delays.</li><li>Maintain dashboards tracking enrollment cycle times and payor activation status.</li><li>Maintain and attest CAQH ProView profiles</li><li>Ensure accuracy across NPI (Type 1 &amp; Type 2), state licenses, DEA (for prescribing clinicians).</li><li>Experience with credentialing/enrollment platforms (e.g., Modio, Verifiable, etc.)</li><li>Ensure compliance with CMS telehealth guidelines, State Medicaid behavioral health policies, NCQA / URAC (if delegated credentialing applies).</li><li>Maintain audit-ready documentation</li></ul><p><b>Must-Have Expertise:</b></p><ul><li>Multi-state Medicaid enrollment (behavioral health)</li><li>Medicare (PECOS) + telehealth billing alignment</li><li>Commercial payor behavioral health networks</li><li>Telehealth-Specific Competencies cross-state practice models, telehealth reimbursement rules</li><li>Ability to identify enrollment errors that cause claim denials in virtual care settings</li><li>High-volume, fast-paced enrollment execution</li><li>Strong tracking and follow-up discipline</li><li>Ability to manage ambiguity (common in telehealth scaling environments)</li></ul><p><b>Qualifications:</b></p><ul><li>3&ndash;6+ years of payor enrollment / credentialing experience</li><li>Medicare + multi-state Medicaid experience is required</li><li>Behavioral health provider enrollment is required</li><li>Telehealth experience is strongly preferred</li><li>Experience onboarding 50+ providers/year is required</li></ul><p>This position offers the opportunity to work in a supportive environment where you can make a meaningful impact on the lives of individuals seeking mental health care.</p><p>Pay: From $27.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>end-to-end provider enrollment across multiple states for BH: 4 years (Required)</li><li>Behavioral health provider enrollment: 4 years (Required)</li></ul><p>Work Location: Remote</p>

Payor Enrollment Specialist – Behavioral Health (Multi-State)

Therapeutic Alliance and Testing Center, LLC

<p>Job Summary</p><p>We are seeking a detail-oriented <b>Insurance Benefits Verification and Authorization Specialist</b> to join our Behavioral Health team. This role is responsible for verifying patient insurance benefits, obtaining prior authorizations for services, and ensuring accurate documentation to support timely billing and reimbursement. The ideal candidate has experience working with behavioral health insurance policies and strong communication skills when interacting with insurance companies, providers, and administrative staff.</p><p>Key Responsibilities</p><ul><li>Verify patient <b>insurance eligibility and behavioral health benefits</b> prior to scheduled appointments.</li><li>Contact insurance companies to confirm <b>coverage details, copays, deductibles, coinsurance, and authorization requirements</b>.</li><li>Obtain <b>prior authorizations</b> for behavioral health services including therapy, psychological testing, and other clinical services.</li><li>Accurately document insurance verification details in the <b>Electronic Health Record (EHR) or billing system</b>.</li><li>Communicate authorization status and benefit information with providers and administrative staff.</li><li>Track authorization approvals, expirations, and follow up on pending requests.</li><li>Assist with resolving insurance verification issues that may impact billing or patient scheduling.</li><li>Maintain compliance with <b>HIPAA and confidentiality standards</b>.</li><li>Support the billing department with claim-related insurance inquiries when needed.</li></ul><p>Qualifications</p><ul><li><b>1&ndash;2 years of experience</b> in insurance verification or medical authorization (Behavioral Health experience preferred).</li><li>Knowledge of <b>commercial insurance, Medicaid, Medicare, and managed care plans</b>.</li><li>Familiarity with <b>prior authorization processes for mental health services</b>.</li><li>Experience working with <b>EHR systems and insurance portals</b>.</li><li>Strong attention to detail and organizational skills.</li><li>Excellent communication and phone etiquette when interacting with insurance representatives.</li><li>Ability to manage multiple tasks and meet deadlines in a fast-paced environment.</li></ul><p>Preferred Qualifications</p><ul><li>Experience in <b>behavioral health or mental health clinics</b>.</li><li>Knowledge of <b>CPT codes related to therapy and psychological testing</b>.</li><li>Experience coordinating with <b>providers, intake coordinators, and billing teams</b>.</li></ul><p>Skills</p><ul><li>Insurance verification</li><li>Prior authorization management</li><li>Medical billing knowledge</li><li>Documentation accuracy</li><li>Problem solving and follow-up</li><li>Time management</li></ul><p>Benefits</p><ul><li>Competitive salary</li><li>Professional development opportunities</li></ul><p>Job Type: Full-time</p><p>Work Location: In person</p>

Insurance Verificiation and Authorization Specialist

State Farm

<div><div><div><b>Benefits:</b></div>
<ul><li>Bonus based on performance</li>
<li>Competitive salary</li>
<li>Opportunity for advancement</li>
<li>Training &amp; development</li>
</ul></div><div><div><b>ROLE DESCRIPTION:</b><br>
Brittany Greene State Farm is seeking a qualified and empathetic professional for the role of Life/Health Insurance Specialist. As a customer-oriented expert, you will market the Life/Health insurance services and products to benefit customers and their families. Your experience equips you to continually grow your income as you provide the necessary support and reassurances.<br>
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As a strategic and emotionally intelligent resource to the community, we are excited to expand our successful agency with your skillset.</div>
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<b>RESPONSIBILITIES:</b>
</div><ul><li>Offer life and health insurance policies to new and existing customers.</li>
<li>Conduct needs analysis to identify insurance products for customers.</li>
<li>Explain policy features, benefits, and exclusions to customers.</li>
<li>Assist customers with claims and policy changes.</li>
<li>Develop and maintain customer relationships.</li>
<li>Stay updated on industry trends and new product offerings.</li>
<li>Ensure compliance with state and federal regulations.</li>
</ul><div><b>QUALIFICATIONS:</b></div>
<ul><li>State insurance license for life and health insurance.</li>
<li>Communication and interpersonal skills.</li>
<li>Ability to understand and explain complex insurance products.</li>
<li>Sales experience, preferably in insurance.</li>
<li>Detail-oriented with excellent organizational skills.</li>
<li>Ability to build and maintain customer relationships.</li>
<li>Proficiency with insurance agency software.</li></ul></div></div>

Life/Health Insurance Position - State Farm Agent Team Member

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