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