Job Description

The Insurance Specialist I is responsible for accounts receivable through insurance claims follow-up, denial management, and appeal. This position requires knowledge of Federal, State, and payor regulations, reimbursement methodologies, and communication with third party payors to facilitate timely and accurate reimbursement.

Essentials Duties 

• A good understanding of medical terminology, to include CPT codes, ICD-10 codes, modifiers and payor policies/guidelines pertaining to assigned specialty.
• Interact with insurance carriers to check claim status and/or dispute denials by telephone and payor websites.
• Utilize payor websites and other resources to conduct research.
• Identify denial trends and communicates findings to leadership.
• Maintains AR over 90 days at or less than 9%.
• Contact patients for additional information when necessary.
• Meets daily, weekly and monthly productivity quotas.
• Work special projects as assigned.
• Other duties as assigned.
• Understand, support and comply with policies, procedures and internal controls in accordance with best business practices across the organization.

Job Qualifications:

• Graduate of Health Insurance Specialist Certificate or Degree program preferred OR High School Diploma. Bachelors preferred.
• Expert working knowledge of EOB’s, copay/coinsurance/deductibles, denial codes, insurance allowable, adjustments, write offs, Understanding of Managed Care contracts, denials and payor methodology.
• Expert knowledge of UB and 1500 claim forms
• Strong knowledge of Medicare, Medicaid, United, Aetna, Humana, Workers Comp and MVA payer and billing policies
• Expert knowledge of CPT and ICD-10 codes
• Knowledge of charge posting and EDI preferred
• Ability to navigate different computer systems
• Accounting Principles, Basic Office Skills required; advanced office skills are preferred.
• Strong communication skills (oral and written); must be able to collaborate effectively and work in a team environment
• Ability to work at a fast pace
• Detail oriented with excellent organization skills