Insurance Specialist 3 – Long Term Care Biller

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 submitting claims to Medicare, Medicaid, and private insurers while ensuring adherence to federal and state billing regulations (including UB-04 and RAI/MDS requirements).

• Verifying coverage and eligibility, as well as resolving claim denials or discrepancies.

• Collaborating with clinical, admissions, and finance teams to ensure precise documentation, maintain patient billing records, and enhance reimbursement through correct coding and prompt claim submission.

• A solid understanding of LTC billing systems, reimbursement models, and payer guidelines is crucial.

• Identifying and reporting trends during the account resolution process, such as CPT/HCPCS errors or deletions, duplicate claims, revenue code mapping errors, missing charges, and claims with no records.

• Conducting financial account assessments, including but not limited to adjustments and determining patient balances.

• Utilizing client systems to complete rebill tasks.

• Performing administrative duties, which may include medical record submissions, billing claims, patient assistance outreach, retrieving documents from client systems, updating insurance plan codes, reviewing corrected claim requests for client assistance, or making necessary billing corrections within the client platform.

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

• Assisting with special projects for clients as required.

• Carrying out other assigned tasks.

⛳️ 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.

• Proficiency with UB04 claim forms, EOBs, and medical records is essential.

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

• Ability to conduct thorough research to resolve complex claims.

• Intermediate mathematical skills (addition, subtraction, ability to identify trends, etc.) are necessary.

• Capability to compile and summarize data effectively.

• Excellent verbal and written communication skills.

• Ability to analyze and interpret complex documents, contracts, notes, and other communications.

• Proficient in prioritizing and multitasking in a fast-paced environment.

• Ability to work efficiently in a remote setting.

• Investigative mindset to identify issues and develop solutions.

🏝️ Benefits

• Medical/Dental/Vision Insurance.

• Equipment provided.

• 401k program.

• Accrued PTO - 80 hours annually.

• Paid Paternity & Maternity leave programs.

• 9 paid annual holidays.

• Tuition reimbursement.

• Opportunities for professional growth and much more!