Insurance Specialist

Job Summary: The Insurance Billing Specialist will work from specific queues to fix any errors on accounts preventing the claim from being submitted to the insurance carriers. The Insurance Specialist contacts insurance carriers and customers to research and resolve outstanding insurance balances in an attempt to recover accounts receivable.

Essential Duties and Responsibilities:

  • Works specific edit queues to determine why the claim has not been submitted, corrects the errors and completes the claim to be billed
  • Works specific denial management queues and researches account balances through internet research and phone calls to insurance companies, patients, and hospitals to resolve accounts that have insurance payments due
  • Aggressively pursues payment from insurance companies
  • Verifies new insurance information provided by guarantor
  • Reviews correspondence, including but not limited to, dispute letters, EOBs, remittances and cancelled checks; after review, inputs information regarding the correspondence into the system and works the correspondence for successive follow-up
  • Field incoming calls from patients and insurance companies to attempt to resolve unpaid account balances
  • Document notes and patient information into the billing system accurately and timely
  • Communicate with management regarding account status and challenges
  • Comply with HIPAA compliance guidelines, policies and procedures to assure confidential information is protected in accordance with the HIPAA rules and regulations.
  • Exhibit exemplary customer service in all interactions

Physical Demands:

The physical demands described here are the representative of those that must be met by an employee to successfully perform the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; talk or hear. The employee must occasionally lift and/or move up to 25 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

While performing the duties of this job, the employee is exposed to computer screens using keyboard functions and other hand usage.

**The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.


Qualifications Requirements:

  • GED or High School Diploma
  • Healthcare Insurance Policy knowledge required, including Medicare and Medicaid
  • Previous experience working in a physician’s office or hospital billing department, two – three years preferable
  • Great communication skills
  • Extensive attention to detail
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