Insurance Specialist
Summary
Processes and verifies health insurance claims, resolves rejections, and ensures accurate adjudication for patients and payers.
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