insurance specialist

ECLARO

<div>
 
 Job Number: 26-00468
 
 
 
 Be at the forefront of innovation. ECLARO is looking for an
 
 Insurance Specialist
 
 for our client in
 
 Chapel Hill, NC.
 
 
 
 ECLARO&rsquo;s client is notable public research university. If you&rsquo;re up to the challenge, then take a chance at this rewarding opportunity!
 
 
 
 Position Overview:
 
 
 
 <ul>
 <li>
 This Insurance Specialist position offers both dental and medical insurance services for the Client.
 </li>
 <li>
 The Insurance Specialist works in all areas of billing and reimbursement, including private dental insurance companies and managed care organizations.
 </li>
 <li>
 This role requires specialized knowledge of insurance industry standards related to billing and reimbursement, along with a strong understanding of accounts receivable.
 </li>
 <li>
 This position collaborates closely with private insurance carriers, particularly those contracted with the clinics.
 </li>
 <li>
 It also requires a comprehensive understanding of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing, and the policies and contracts of multiple insurance vendors.
 
 
 </li>
 </ul>
 
 Pay Rate:
 
 $24.00/Hour
 
 
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 The responsibilities of this role include filing dental insurance claims and pre-treatment estimates for privately insured patients.
 </li>
 <li>
 Obtaining and providing the clinical documentation necessary for claims processing, such as x-rays, chart notes, and letters of necessity.
 </li>
 <li>
 Investigating denied claims, following up on those investigations, and submitting appeals for those denied claims.
 </li>
 <li>
 Verifying essential documentation including insurance cards, insurance explanations of payment, provider narratives, and insurance consent.
 </li>
 <li>
 Regularly auditing patient records for accuracy and completeness of billing, coding, and clinical documentation.
 </li>
 <li>
 This position will require extensive communication with various insurance companies, along with effective use of insurance portals.
 </li>
 <li>
 Effective communication and deductive reasoning are essential skills.
 </li>
 <li>
 Compliance with HIPAA regulations is mandatory.
 </li>
 <li>
 Other duties as assigned.
 
 
 </li>
 </ul>
 
 If hired, you will enjoy the following ECLARO Benefits:
 
 
 
 <ul>
 <li>
 401k Retirement Savings Plan administered by Merrill Lynch
 </li>
 <li>
 Commuter Check Pretax Commuter Benefits
 </li>
 <li>
 Eligibility to purchase Medical, Dental &amp; Vision Insurance through ECLARO
 
 
 </li>
 </ul>
 If interested, you may contact:
 
 
 
 Lester Candilado
 
 
 
 
 jan.candilado@eclaro.com
 
 
 
 
 6466800168
 
 
 
 
 Lester Candilado | LinkedIn
 
 
 
 
 Equal Opportunity Employer:
 
 ECLARO values diversity and does not discriminate based on Race, Color, Religion, Sex, Sexual Orientation, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status, in compliance with all applicable laws.
</div>

Insurance Specialist

Avera Health

<div><div><div><div><div><div><div><div>Location:
</div></div></div></div></div></div></div>Avera Marshall Hospital
Worker Type:
Regular
Work Shift:
Day Shift (United States of America)
Pay Range:
The pay range for this position is listed below. Actual pay rate dependent upon experience.
$19.50 - $25.50
Position Highlights
Monday - Friday, 8:00 AM - 4:30 PM 
 
You Belong at Avera
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. 
 
A Brief Overview
 
 
Responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Specialists must also be able to understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities in order to provide patients and families with information on their financial responsibility. The Specialist will calculate and communicate to the patient a financial responsibility estimation, provide charity applications and/or direct the patient to the business office for payment and assistance options. The Specialists will collect patient liability prior to service and attempt to collect prior balances. The Specialist collaborates with various other departments to ensure proper reimbursement on accounts. The Specialists are to conduct all transactions appropriately and consistently, and complete government regulatory forms accurately with the patient or patient's representative. Specialists must maintain compliance with government regulations (i.e. EMTALA and HIPAA) as it pertains to the insurance process.
 
 
What you will do 
 
 
<ul><li>Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
</li><li>Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care.
</li><li>Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into the health information system.
</li><li>Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information.
</li><li>Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator to determine estimated patient responsibility and communicates financial expectations to the patient.
</li><li>Educates patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered, and identifies methods of payment available. Identifies patients in need of financial assistance and provides charity applications and referrals to the business office as necessary.
</li><li>Responsible to screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. Assure all payer requirements are met, including non-coverage waivers, Advance Beneficiary Notices, sterilization forms, and other forms as applicable.
</li><li>Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff.
</li><li>Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.
</li></ul> 
Essential Qualifications
 
 
The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
 
 
Required Education, License/Certification, or Work Experience: 
 
 
<ul><li>1-3 years Related experience in billing, insurance or registration.
</li><li>1-3 years Healthcare experience
</li></ul> 
Preferred Education, License/Certification, or Work Experience: 
 
 
<ul><li>Associate's finance, business or healthcare.
</li></ul> 
Expectations and Standards 
 
 
<ul><li>Commitment to the daily application of Avera&rsquo;s mission, vision, core values, and social principles to serve patients, their families, and our community.
</li><li>Promote Avera&rsquo;s values of compassion, hospitality, and stewardship.
</li><li>Uphold Avera&rsquo;s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
</li><li>Maintain confidentiality.
</li><li>Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
</li>Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. 
<li>
</li></ul> 
Benefits You Need &amp; Then Some
Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.
<ul><li>PTO available day 1 for eligible hires.
</li><li>Up to 5% employer matching contribution for retirement
</li><li>Career development guided by hands-on training and mentorship
</li></ul>Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org .</div>

HCA Healthcare

<div>**After 90 days, Hybrid/Remote work may be available &ndash; Interested candidates must live in the local Kansas City metro area.** Hours: 7:30AM-4:00PM**
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As an Insurance Specialist with HCA Healthcare you can be a part of an organization that is devoted to giving back!
<h5 class="jobSectionHeader">Job Summary and Qualifications</h5>
As the Collections Representative, you will contribute to the company&rsquo;s mission, vision, and values by completing follow-up and collections for patient services. Under the supervision of the Business Office Manager/Business Office Supervisor, you will obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts.
What you will do in this role:<ul><li>
You will perform follow up activities on accounts to ensure prompt payment</li><li>
You will identify coding or billing errors from EOBs and work to correct them</li><li>
You will monitor insurance claims and contact insurance companies to resolve claims</li><li>
You will update the patient account record to identify actions taken</li><li>
You will assign bad debt to the collection agency</li><li>
You will act as a liaison accounts and administer contracts in collection of third partyaccounts (Medicare and Medicaid)</li><li>
You will complete account reconciliation of accounts turned over to outside agencies</li><li>
You will negotiate payment plans on self-pay accounts</li><li>
You are responsible for maintaining accounts receivable and creating a reduction in bad debt</li></ul>
Qualifications you will need:<ul><li>
Minimum (1) year of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office) preferred</li><li>
Knowledge of managed care payers and medical terminology is preferred</li></ul>
<h5 class="jobSectionHeader">Benefits</h5>
HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
At the Surgery Ventures Central Business Office in MidAmerica, we support financial and patient care operations of 10 ambulatory surgery centers across the Kansas City Metro. Staff are assigned to work with one or more surgery centers via remote, in office and hybrid working environments.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 
&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Insurance Specialist opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Arkansas Children's

<div>ARKANSAS CHILDREN'S IS A TOBACCO FREE WORKPLACE. FLU VACCINES ARE REQUIRED. ARKANSAS CHILDREN'S IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, DISABILITY, PROTECTED VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE, OR LOCAL LAWS.
This position has been designated as safety sensitive and cannot be filled by a candidate who is a current user of medical marijuana.
CURRENT EMPLOYEES: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/)and search the &quot;Find Jobs&quot; report.
Work Shift:
Day Shift
Time Type:
Full time
Department:
CC017115 Outpatient Prior Authorizations<h2 class="jobSectionHeader">
Summary:</h2><h2 class="jobSectionHeader">
Additional Information:</h2>
Responsible for the pre-verification of insurance for patients being admitted into the hospital for care. Ensures insurance coverage, resolves any issues with coverage and escalates complicated issues. Verifies, interprets, coordinates, disseminates insurance information; establishes and counsels patient on co-payments, maintains charge capture information.<h2 class="jobSectionHeader">
Required Education:</h2>
No education requirements<h2 class="jobSectionHeader">
Recommended Education:</h2>
High school diploma or GED or equivalent<h2 class="jobSectionHeader">
Required Work Experience:</h2>
Entry Level - Experience not Required.<h2 class="jobSectionHeader">
Recommended Work Experience:</h2><h2 class="jobSectionHeader">
Required Certifications:</h2><h2 class="jobSectionHeader">
Recommended Certifications:</h2><h1 class="jobSectionHeader">
Description</h1>
1. Obtains pre-authorization approvals for outpatient procedures from the Surgery, Day Medicine, Radiology, Nuclear Medicine, Genetics, Sleep lab and Heart Station departments. 
 
2. Preregisters, obtains prior authorization, price estimates, PCP referrals, upfront collections and referred accounts prior to date of service. 
 
3. Obtains prior authorizations and insurance verification for all clinics, Medicare patients, out-of-state Medicaid, SDC and for specialty drugs. 
 
4. Obtains the appropriate prior authorizations for surgical and outpatient procedures and the necessary CPT/ICD-10 diagnosis codes when appropriate. 
 
5.Obtains price estimates, upfront collections and referred accounts prior to date of service. 
 
6.Completes outbound calls to families regarding insurance coverage and benefits, high deductibles, co-pays, denials. 
 
7. Conducts appropriate follow-ups and verifications on all assigned accounts including documenting in the patients account detailed insurance information prior to services being rendered. 
 
8. Ensures that pre-certifications, pre-notifications, prior authorizations or referrals are received for each account with a financial class of insurance and/or Medicaid. 
 
9. Appropriately refers all high dollar or self-pay accounts to Financial Counselor. 
 
10. Serves as a liaison between the clinical staff and insurance payers. 
 
11. Collects deductible, co-pay and all other applicable payments. 
 
12. Performs other duties as assigned.</div>

Insurance Specialist I

South County Hospital

<div><div>Position Summary: Serves as the organization&rsquo;s subject matter expert in claims and insurance program operations, managing claims, litigation, and risk financing, including the self-insured trust and all commercial insurance coverages.
Coordinates with legal counsel, insurers, and brokers to ensure timely, accurate claims management, regulatory compliance, and insurance renewals. Partners with the Director of Risk Management/Patient Safety to support event reporting and investigations, translating claims and litigation experience into insights that drive patient safety and risk mitigation. With regard to claims and litigation, takes actions under the direction of the General Counsel, external legal counsel, and Claims/Risk Committee.
Provides cross-functional support, including coverage of Director and Risk Analyst responsibilities as appropriate, to ensure continuity of operations and alignment of risk, claims, and patient safety efforts. 

Essential Responsibilities
Claims &amp; Litigation Management
<ul><li>Manage all potentially compensable events, claims, and litigation across professional and general liability and other applicable coverage.
</li><li>Maintain complete, accurate, and organized claims and litigation files within the RLDatix Claims module
</li><li>Coordinate claims intake, investigation documentation, and case file development
</li><li>Under supervision of General Counsel, serve as liaison with insurance carriers, claims representatives, defense counsel, and internal stakeholders
</li><li>Support and coordinate legal processes, including discovery, document production, interrogatories, and information requests
</li><li>Coordinate depositions, testimony, and meetings between staff and legal counsel
</li><li>Manage subpoenas and legal requests, ensuring appropriate handling and coordination
</li><li>Participate in early resolution strategies and settlement preparation pursuant to the direction of General Counsel and external legal counsel.</li>
<li>Maintain awareness of claim exposure, reserves (as applicable), and case status
</li><li>Chair the organization&rsquo;s Claims Committee and coordinate case review activities
</li><li>Ensure timely and accurate regulatory reporting of claims and litigation[AP1] (e.g., Rhode Island DBR requirements)
</li></ul>Insurance Program Oversight
<ul><li>Direct day-to-day operations of the organization&rsquo;s insurance program, including the self-insured trust (Circle Protection Plan) and all commercial lines of coverage
</li><li>Serve as primary liaison with the organization&rsquo;s insurance broker
</li><li>Lead all insurance renewal activities, ensuring accurate, timely, and complete submission of applications and required documentation
</li><li>Coordinate data collection and underwriting submissions across internal departments
</li><li>Maintain oversight of policy coverage, limits, and reporting requirements
</li><li>Oversee and participate in timely reporting of actual and potential claims to applicable carriers, including First Notice of Loss (FNOL)
</li><li>Provide claims loss runs and certificates of insurance (COIs) for providers and organizational needs
</li><li>Oversee processes related to provider coverage, including new provider quotes and extended reporting period (tail) coverage for departing providers
</li><li>Maintain insurance documentation and renewal timelines
</li></ul>Claims-to-Safety Integration
<ul><li>Collaborate with the Director of Risk and Patient Safety and Risk Analyst to share trends, themes, and lessons learned from claims and litigation activity
</li><li>Contribute to the development of prevention strategies by translating claim experience into actionable insights
</li><li>Support structured communication of aggregated claim themes and closed-case learning to leadership and medical staff
</li></ul>Operational Coordination
<ul><li>Maintain organized workflows and documentation to support consistent claims and insurance operations
</li><li>Coordinate meetings, reporting, and documentation related to claims and insurance activities
</li><li>Support departmental planning and improvement initiatives
</li><li>Contribute to cross-training and knowledge sharing within the Risk &amp; Patient Safety department
</li></ul>Qualifications
Required
<ul><li>Bachelor&rsquo;s degree in healthcare administration, business, nursing, or related field
</li><li>3+ years of experience in claims management, healthcare risk management, insurance operations, or related field
</li><li>Experience working with claims management systems (e.g., RLDatix or similar)
</li><li>Strong organizational, analytical, and problem-solving skills, including experience analyzing data to identify trends and inform decision-making
</li><li>Ability to manage multiple complex processes simultaneously, ensuring accuracy and compliance</li>
<li>Excellent communication and collaboration skills, with the ability to work across departments and with external partners
</li></ul>Preferred
<ul><li>Claims adjuster experience or certification
</li><li>Experience with self-insured trusts or healthcare insurance programs
</li><li>Familiarity with healthcare regulatory reporting requirements
</li><li>Experience working with legal counsel and litigation processes</li></ul><div> 

</div></div> 
Location: South County Hospital &middot; Administration 
Schedule: Full Time, day, M-F</div>

Risk, Claims, & Insurance Specialist

Ogden Clinic

<div>Under the direct supervision of the Business Services Assistant Manager, the Insurance Resolution Specialist is responsible for all issues relating to patient accounts receivable. 


Ogden Clinic provides competitive pay and benefits. Full-Time employees have access to:
<ul>
<li>Medical (including a partially company funded HSA option and in-house discount plan)</li>
<li>Dental, Vision, Disability and other plan coverage options.</li>
<li>Company paid life insurance for employees and their families.</li>
<li>Employee Assistance Program that provides free counseling to employees and their families.</li>
<li>Paid Time Off and Holidays</li>
<li>Scholarship Program</li>
<li>401k with generous profit sharing contributions.</li>
<li>In nearly all cases, no nights, weekends or holiday shifts.</li>
<li>Competitive pay starting at $17.00+ an hour depending on experience.</li>
<li>Annual Performance/Merit Increase Program that offers up to a 5% pay increase.</li>
<li>Salary ranges reviewed annually.</li>
<li>Limited benefits for non-Full-Time employees.</li>
</ul>
Full job description is available upon request by emailing talent@ogdenclinic.com</div>

Insurance Resolution Specialist

Inner Illumination Therapy and Counseling, LLC

Overview Join our dynamic healthcare team as an Insurance Verification Specialist, where your expertise will be essential in ensuring seamless insurance processing and patient care. In this vital role, you&rsquo;ll be the first point of contact for verifying patient insurance coverage, managing medical records, and coordinating with insurance providers to facilitate accurate billing and reimbursement. Your energetic approach and attention to detail will help streamline operations and support our mission of delivering exceptional healthcare services.Responsibilities<ul><li>Verify patient insurance coverage accurately by contacting insurance companies and reviewing policy details.</li><li>Obtain pre-authorizations and referrals as required by managed care plans to ensure timely patient access to services.</li><li>Review and update medical records, ensuring all documentation complies with HIPAA regulations and confidentiality standards.</li><li>Utilize medical terminology, CPT coding, ICD-9, ICD-10, and ICD coding to interpret clinical information for billing purposes.</li><li>Communicate effectively with medical offices, dental offices, and other healthcare providers to confirm patient eligibility and coverage details.</li><li>Maintain detailed records of insurance verification activities, updates, and correspondence for audit readiness.</li><li>Collaborate with the billing department to resolve any discrepancies or issues related to insurance claims or coverage.</li></ul>Requirements<ul><li>Proven experience in medical office administration or healthcare insurance verification.</li><li>Strong knowledge of managed care processes, medical terminology, and medical coding systems including CPT, ICD-9, ICD-10, and ICD coding.</li><li>Familiarity with HIPAA regulations to ensure patient privacy and data security at all times.</li><li>Prior office experience in a healthcare setting, preferably in dental or general medical offices.</li><li>Excellent communication skills for liaising with insurance companies, healthcare providers, and patients.</li><li>Ability to handle sensitive information with professionalism and accuracy.</li><li>Knowledge of medical records management and insurance verification procedures is highly desirable. Embrace this opportunity to energize your career while making a meaningful difference in patient care! We&rsquo;re dedicated to fostering a supportive environment where your skills thrive as you help us deliver top-tier healthcare services efficiently and confidently.</li></ul>Pay: $23.81 - $28.67 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li><li>Professional development assistance</li></ul>Work Location: Remote

Insurance Verification Specialist

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Insurance Verification Specialist