medical insurance claims processor

AAA The Auto Club Group

<div><p>It&rsquo;s a great time to join AAA The Auto Club Group!
</p><p></p><p><b>JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD
</b></p><p></p><p><b>Job Type:
</b></p><p></p>Full time<br>
<p></p><div><div><p><b>Exempt/Non Exempt:<br>
</b></p></div></div><p></p>Salary
<p></p><p><b>Job Description:<br>
</b></p><p></p><br>
<br>
<h2 class="jobSectionHeader"><b>Intermediate Michigan PIP Claim Specialist &ndash; The Auto Club Group
</b></h2><h2 class="jobSectionHeader"><b>Reports to: </b><b>Claim Manager as appropriate
</b></h2><p></p><h2 class="jobSectionHeader"><b>What you will do </b><b>:
</b></h2><h2 class="jobSectionHeader"><b>The Auto Club Group is seeking prospective </b><b>Claim Specialist </b><b>who will work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.
</b></h2><p></p><h2 class="jobSectionHeader"><b>In this position, you will have the opportunity to:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Complete complex coverage analysis.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Ensure all possible policyholder benefits are identified.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Create additional sub-claims if needed.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Evaluate the financial value of the loss.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Approve payments for the appropriate parties accordingly.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
</b></h2></li><li><h2 class="jobSectionHeader"><b>Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
</b></h2></li><li><h2 class="jobSectionHeader"><b>Utilize strong negotiating skills.
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Claim Specialists are assigned to the PIP unit and are responsible for Michigan PIP intermediate claims involving fractures, mild closed head injuries, surgical procedures, and claims involving attendant care. The role may require proficiency in dealing with the MCCA and attorney represented claims. May handle losses beyond those identified previously. Work with insureds, physicians&rsquo; offices and medical insurance carriers to obtain necessary information to complete the claims review process and make the appropriate determinations
</b></h2><p></p><h2 class="jobSectionHeader"><b>With our powerful brand and the mentoring, we offer, you will find your position as a </b><b>Claim Specialist </b><b>can lead to a rewarding career at our growing organization.
</b></h2><p></p><h2 class="jobSectionHeader"><b>Work Environment
</b></h2><h2 class="jobSectionHeader"><b>This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
</b></h2><p></p><h2 class="jobSectionHeader"><b>How you will benefit </b><b>:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>A competitive annual salary between </b><b>$67,300 to $75,000
</b></h2></li><li><h2 class="jobSectionHeader"><b>ACG offers excellent and comprehensive benefits packages, including:
</b></h2></li><li><h2 class="jobSectionHeader"><b>Medical, dental and vision benefits
</b></h2></li><li><h2 class="jobSectionHeader"><b>401k Match
</b></h2></li><li><h2 class="jobSectionHeader"><b>Paid parental leave and adoption assistance
</b></h2></li><li><h2 class="jobSectionHeader"><b>Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
</b></h2></li><li><h2 class="jobSectionHeader"><b>Paid volunteer day annually
</b></h2></li><li><h2 class="jobSectionHeader"><b>Tuition assistance program, professional certification reimbursement program and other professional development opportunities
</b></h2></li><li><h2 class="jobSectionHeader"><b>AAA Membership
</b></h2></li><li><h2 class="jobSectionHeader"><b>Discounts, perks, rewards, and much more
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>We&rsquo;re looking for candidates who </b><b>:
</b></h2><p></p><h2 class="jobSectionHeader"><b>Required Qualifications (these are the minimum requirements to qualify):
</b></h2><h2 class="jobSectionHeader"><b>Education:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
</b></h2></li><li><h2 class="jobSectionHeader"><b>In states where an Adjuster&rsquo;s license is required, the candidate must be eligible to acquire a State Adjuster&rsquo;s license within 90 days of hire and maintain as specified for appropriate states.
</b></h2></li><li><h2 class="jobSectionHeader"><b>A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Experience:
</b></h2><h2 class="jobSectionHeader"><b>Three years of experience or equivalent training in the following:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Negotiation of claim settlements
</b></h2></li><li><h2 class="jobSectionHeader"><b>Securing and evaluating evidence
</b></h2></li><li><h2 class="jobSectionHeader"><b>Preparing manual and electronic estimates
</b></h2></li><li><h2 class="jobSectionHeader"><b>Subrogation claims
</b></h2></li><li><h2 class="jobSectionHeader"><b>Resolving coverage questions
</b></h2></li><li><h2 class="jobSectionHeader"><b>Taking statements
</b></h2></li><li><h2 class="jobSectionHeader"><b>Establishing clear evaluation and resolution plans for claims
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Knowledge and Skills:
</b></h2><h2 class="jobSectionHeader"><b>Advance knowledge of:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Essential Insurance Act (Michigan)
</b></h2></li><li><h2 class="jobSectionHeader"><b>Fair Trade Practices Act as it relates to claims
</b></h2></li><li><h2 class="jobSectionHeader"><b>Subrogation procedures and processes
</b></h2></li><li><h2 class="jobSectionHeader"><b>Intercompany arbitration
</b></h2></li><li><h2 class="jobSectionHeader"><b>Handling simple litigation
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Advance knowledge of:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Negligence Law
</b></h2></li><li><h2 class="jobSectionHeader"><b>No-Fault Law
</b></h2></li><li><h2 class="jobSectionHeader"><b>medical terminology and human anatomy
</b></h2></li><li><h2 class="jobSectionHeader"><b>MCCA and attorney represented claims
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Ability to </b><b>:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Handle claims to the line Claim Handling Standards
</b></h2></li><li><h2 class="jobSectionHeader"><b>Follow and apply ACG Claim policies, procedures and guidelines
</b></h2></li><li><h2 class="jobSectionHeader"><b>Work within assigned ACG Claim systems including basic PC software
</b></h2></li><li><h2 class="jobSectionHeader"><b>Perform basic claim file review and investigations
</b></h2></li><li><h2 class="jobSectionHeader"><b>Demonstrate effective communication skills (verbal and written)
</b></h2></li><li><h2 class="jobSectionHeader"><b>Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
</b></h2></li><li><h2 class="jobSectionHeader"><b>Analyze and solve problems while demonstrating sound decision-making skills
</b></h2></li><li><h2 class="jobSectionHeader"><b>Prioritize claim related functions
</b></h2></li><li><h2 class="jobSectionHeader"><b>Process time sensitive data and information from multiple sources
</b></h2></li><li><h2 class="jobSectionHeader"><b>Manage time, organize and plan workload and responsibilities
</b></h2></li><li><h2 class="jobSectionHeader"><b>Research, analyze, and interpret subrogation laws in various states
</b></h2></li></ul><p></p><h2 class="jobSectionHeader"><b>Preferred Qualifications:
</b></h2><h2 class="jobSectionHeader"><b>Education </b><b>:
</b></h2><ul><li><h2 class="jobSectionHeader"><b>Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
</b></h2></li><li><h2 class="jobSectionHeader"><b>Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent
</b></h2></li><li><h2 class="jobSectionHeader"><b>CPCU coursework or designation
</b></h2></li></ul><p></p><p>#LI-LC1
</p><p></p><p>Who We Are
</p><p>Become a part of something bigger.
</p><p></p><p>The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
</p><p></p><p>By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life&rsquo;s journey through insurance, travel, financial services, and roadside assistance.
</p><p></p><p>And when you join our team, one of the first things you&rsquo;ll notice is that same, whole-hearted, enthusiastic advocacy for each other.
</p><p></p><p>We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
</p><p></p><p>To learn more about AAA The Auto Club Group visit www.aaa.com
</p><p></p><p>Important Note:
</p><p></p><p>ACG&rsquo;s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
</p><p></p><p>The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
</p><p></p><p>The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
</p><p></p><p>Regular and reliable attendance is essential for the function of this job.
</p><p></p><p>AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.</p></div>

Intermediate Michigan PIP Claim Specialist

Nephrology Associates of Central Fl

<p>We are looking for an experienced Medical Accounts Receivable Representative who will be responsible for the collections of medical insurance claims, dialysis referrals, payment posting, charge entry, etc. with direct medical billing experience.</p><p><b>Responsibilities</b></p><ul><li>Researches all information needed to complete billing process.</li><li>Backup to Receptionist (answering hospital and patient calls when Receptionist is away from desk)</li><li>Transcribes data from source documents and enters into computer files including billing/charge information.</li><li>Screens and reviews source documents at time of entry for proper completion and accuracy. Reviews output for accuracy of data input. Enter correcting entries.</li><li>Participates with other staff to follow up on accounts until no balance or turned over for collection. Follows-up with insurance companies ensuring that coverage and benefits are approved and claims are processed and paid.</li><li>Assists with coding and error resolution. Posts all actions and maintains permanent record of patient accounts.</li><li>Answers telephone calls and provides information as requested. Answers patient questions and inquiries.</li><li>Maintains strictest confidentiality. Communicates questions or concerns for prompt resolution.</li><li>Prints daily report and balances all entries. Reviews the data input for completeness and accuracy.</li><li>Other duties as assigned.</li></ul><p><b>Skills</b></p><ul><li>Strong knowledge of Medical insurances</li><li>Basic knowledge of coding</li><li>Solid understanding of insurance payor requirements for claim follow up</li><li>Proven ability to navigate payor websites (Medicare, Medicaid, Availity, UHC)</li><li>Data entry skills along with a knack for numbers</li><li>Ability to accurately balance payments and daily/monthly payments</li><li>Hands-on experience in claims</li><li>Proficiency MS Office</li><li>Customer service orientation and negotiation skills</li><li>High degree of accuracy and attention to detail</li><li>Strong attention to detail required</li><li>Self-Motivated</li><li>Experience with Epic preferred</li></ul><p>Job Type: Full-time</p><p>Pay: $20.00 - $21.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>Medical Billing: 1 year (Required)</li></ul><p>Work Location: In person</p>

A/R Representative

Moda Health

<div><p><b>Let&rsquo;s do great things, together!</b></p><p><b>
About Moda</b><br>
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let&rsquo;s be better together.</p><p><b><br>
Position Summary</b><br>
Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims. Answer internal questions from various departments and respond to correspondence from providers when necessary. <b>This is a FT WFH role.</b><br>
<br>
<b>Pay Range</b><br>
$21.30 - $23.96 hourly (depending on experience) *Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.</p><p><b><br>
Please fill out an application on our company page, linked below, to be considered for this position.</b></p><p>
https://j.brt.mv/jb.do?reqGK=27772651&amp;refresh=true</p><p><b><br>
Benefits</b><b>:</b></p><ul><li>
Medical, Dental, Vision, Pharmacy, Life, &amp; Disability</li><li>
401K- Matching</li><li>
FSA</li><li>
Employee Assistance Program</li><li>
PTO and Company Paid Holidays</li></ul><p></p><p><b><br>
Required Skills, Experience &amp; Education:</b></p><ul><li>
High School diploma or equivalent.</li><li>
1-2 years medical claims processing experience.</li><li>
10-key proficiency of 135 wpm.</li><li>
Type a minimum of 35 wpm.</li><li>
Knowledge of medical terminology, CPT codes and ICD-10 codes.</li><li>
Strong verbal, written, and interpersonal communication skills.</li><li>
Analytical, problem solving and organizational skills.</li><li>
Ability to work well under pressure.</li><li>
Maintain confidentiality and project a professional business image</li><li>
Ability to maintain balanced performance in areas of production and quality.</li></ul><p><b><br>
Primary Functions</b><b>:</b></p><ul><li>
Review, process and adjust Commercial and Medicaid inpatient claims.
</li><li>Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.</li><li>
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
</li><li>Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS).
</li><li>Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
</li><li>Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
</li><li>Contact providers and other outside sources for additional information.</li><li>
Adjudicate claims to achieve quality and production standards applicable to the position.</li><li>
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.</li><li>
Review Policy and Procedures (P&amp;P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.</li><li>
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.</li><li>
Perform other duties as assigned.</li></ul><p><b><br>
Working Conditions &amp; Contact with Others</b></p><ul><li>
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.</li><li>
Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.</li></ul><p><b><br>
Together, we can be more. We can be better.</b><br>
<br>
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.<br>
<br>
For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.</p></div>

Inpatient Claims Processor I

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

NTT DATA

<div>NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and their team.
<br>
In this Role the candidate will be responsible for:<br>
<ul><li>Processing of Professional claim forms files by provider</li><li>Reviewing the policies and benefits</li><li>Comply with company regulations regarding HIPAA, confidentiality, and PHI</li><li>Abide with the timelines to complete compliance training of NTT Data/Client</li><li>Work independently to research, review and act on the claims</li><li>Prioritize work and adjudicate claims as per turnaround time/SLAs</li><li>Ensure claims are adjudicated as per clients defined workflows, guidelines</li><li>Sustaining and meeting the client productivity/quality targets to avoid penalties</li><li>Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.</li><li>Timely response and resolution of claims received via emails as priority work</li><li>Correctly calculate claims payable amount using applicable methodology/ fee schedule</li></ul><br>
Requirements:<br>
<ul><li>3 year(s) hands-on experience in Healthcare Claims Processing</li><li>2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools</li><li>High school diploma or GED.</li><li>Previously performing - in P&amp;Q work environment; work from queue; remotely</li><li>Key board skills and computer familiarity -</li></ul>
o Toggling back and forth between screens/can you navigate multiple systems.<br>
o Working knowledge of MS office products - Outlook, MS Word and MS-Excel.<br>
<br>
Preferred Skills &amp; Experiences:<br>
<ul><li>Amisys</li><li>Ability to communicate (oral/written) effectively in a professional office setting</li><li>Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities</li><li>Time management with the ability to cope in a complex, changing environment</li></ul></div>

Medical Claims Processor, Remote Temporary

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>
<br>
<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>
</div>
</div></div></div><br>
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

Auxiant

<div><p>https://www.auxiant.com/</p><p><b>
Auxiant&rsquo;s Mission Statement and Core Values</b></p><p><b>
Mission:</b><br>
An Independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL Results.</p><p><b>
Core Values:</b> Independent Solutions. <b>REAL</b> Results<br>
<b>R</b>espect<br>
<b>E</b>mpowerment<br>
<b>A</b>gility<br>
<b>L</b>eadership</p><p>
Be part of a growing and prospering company as a Benefit Setup Specialist. Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing,progressive company offering an excellent wage and benefit package.</p><p><b>
Job Summary:</b></p><p>
You will be responsible for interpreting complex health benefits information from written documents and accurately inputting the relevant data into our claims processing system.</p><p><b>
Essential Functions:</b></p><ul><li>
Analysis and configuration of group benefit health plans</li><li>
Demonstrate organized and effective project management skills</li><li>
Participate in internal and external meetings regarding plan designs and coding</li><li>
Improve system auto adjudication through claims logic coding and plan design</li><li>
Create/Modify summary of benefits for each new/changed plan</li><li>
Cross-audit plan documents for benefit accuracy</li><li>
Answer processor questions regarding benefits and plan build</li><li>
Suggest improvements in processes</li></ul><p><b>
Nonessential Functions:</b></p><ul><li>
Other duties as assigned or appropriate</li></ul><p><b>
Education/Qualifications:</b></p><ul><li>
Ideal candidate will have 2 plus years of self-funded health insurance industry experience, with experience in benefit programming and specific knowledge of Trizetto&rsquo;s Qiclink claims software.</li><li>
Strong knowledge of health insurance terminology, coding systems (e.g., CPT, ICD-10), and industry practices.</li><li>
Excellent attention to detail and the ability to interpret complex documents accurately.</li><li>
Effective communication skills and the ability to collaborate with cross-functional teams.</li><li>
Ability to work in a fast-paced environment and meet tight deadlines</li></ul><p>
Full benefits including: Medical, Dental, Vision, Flexible Spending, Gym Membership Reimbursement, Life Insurance, LTD, STD, 401K, 3 weeks vacation, 9 paid holidays, casual dress code and more</p></div>

Benefit Setup Specialist

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