Insurance Specialist

Key Responsibilities:

- Follow up on claim status via insurance portals or calls to payers to determine adjudication and details.

- Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage.

- Verify patient insurance eligibility and coordination of benefits.

- Review and analyze payer correspondence.

- Investigate electronic claim rejections.

- Submit claims for processing corrections, to secondary insurances, or to updated addresses.

- Research requests for insurance payment retractions.

- Monitor and notify management of payer trends and/or claim processing issues.

- Meet or exceed productivity and quality KPI goals.

- Perform other duties as assigned.

Education/Experience:

- High School diploma or GED

- Previous health insurance billing experience

- Working knowledge of medical terminology

- Strong problem-solving skills and the ability to adapt to changes in policies, regulations, and procedures

- Excellent written and verbal communication skills

- High attention to detail

- Ability to interact effectively with others

- Ability to maintain confidentiality

- Proficient computer skills with knowledge of Microsoft Word and Excel

Originally posted on Himalayas