Insurance Specialist 3

This is a fully remote position, open to applicants in Hawaii.

📋 Description

• Addressing intricate, high-value unpaid or denied claims related to long-term care (LTC), skilled nursing facilities (SNF), or intermediate care facilities (ICF).

• Preparing and filing claims with Medicare, Medicaid, and private insurance companies; ensuring adherence to federal and state billing guidelines (including UB-04 and RAI/MDS requirements); verifying coverage and eligibility; and resolving claim denials or inconsistencies.

• Collaborating with clinical, admissions, and finance teams to ensure precise documentation, maintaining patient billing records, and enhancing reimbursement through accurate coding and prompt claim submission.

• Having a solid understanding of LTC billing systems, reimbursement models, and payer regulations is crucial.

• Detecting and reporting trends during the account resolution process, such as CPT/HCPCS errors or deletions, duplicate claims, revenue code mapping discrepancies, missing charges, and claims not on file.

• Conducting financial account assessments, which include adjustments and determining balances owed by patients.

• Utilizing client systems to execute rebilling tasks.

• Performing administrative duties such as submitting medical records, billing claims, outreach for patient assistance, retrieving documents from client systems, updating insurance plan codes, reviewing corrected claim requests for client assistance, and amending bills within the client platform, as well as reviewing and submitting payment verification assistance requests.

• Staying informed about client preferences and known issues across various client accounts.

• Assisting with special projects for clients as required.

• Other responsibilities as assigned.

⛳️ Requirements

• High School Diploma or equivalent.

• Over 5 years of relevant industry experience in registration, billing, and collections is required.

• At least 3 years of experience in LTC and/or SNF claims resolution is mandatory.

• Familiarity with UB04 claim forms, Explanation of Benefits (EOBs), and medical records is essential.

• Knowledge of ICD-9, ICD-10, CPT, and HCPCS coding is required.

• Ability to perform in-depth research to resolve complex claims.

• Intermediate math skills (addition, subtraction, trend identification, etc.) are necessary.

• Skills in compiling and summarizing data.

• Excellent verbal and written communication abilities.

• Capability to analyze and interpret complex documents, contracts, notes, and other correspondence.

• Proficiency in prioritizing tasks and multitasking in a dynamic environment.

• Ability to work efficiently in a remote setting.

• An investigative mindset for identifying issues and implementing solutions.

🏝️ Benefits

• Competitive hourly salary.

• Medical, dental, and vision insurance.

• Equipment provided.

• 401k program.

• Accrued PTO - 80 hours annually.

• Paid paternity and maternity leave programs.

• 9 paid annual holidays.

• Tuition reimbursement.

• Opportunities for professional growth and much more!