Insurance Specialist I

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

📋 Description

• Manage a high volume of unpaid or incorrectly compensated claims to ensure reimbursement.

• Execute medical billing functions for claims submitted to third-party payers.

• Analyze unpaid claims and denials, appeal and rebill claims, and make corrections to resubmit claims.

• Follow up with insurance companies regarding services that are unpaid or incorrectly compensated.

• Assist patients in understanding insurance billing claims and respond to questions regarding collections.

• Write off uncollectible balances up to $500, based on experience.

• Address claim edits before they are submitted to insurance companies.

• Review and process refunds from payers.

• Monitor and track denials, identify trends, and develop action plans for systemic payer issues.

• Collaborate with vendors to resolve issues related to payers.

• Correct posting discrepancies and investigate unposted payments.

• Coordinate with the credentialing liaison regarding provider enrollment matters.

• Acquire retroactive authorizations or referral numbers from referring physician offices.

• Contact clients regarding overdue group-bill accounts and discrepancies in charges.

• Provide patient eligibility status for patients on-site.

• Participate in monthly and quarterly meetings, train with colleagues, conduct peer-to-peer quality assurance, and communicate updates to leadership.

• Undertake other special projects and responsibilities as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• Two years of medical billing coursework is preferred.

• Experience in patient accounts billing is desired.

• Familiarity with Medinformatix or other patient accounting systems is advantageous.

• Experience with CPT and ICD-10 coding is preferred.

• Strong customer service skills are essential.

• Proficiency in Microsoft Office products (Outlook, Word, Excel), Workday, Internet, Intranet, Meditech, Code Correct, Medinformatix, and Waystar is highly desired.

• Successful completion of a background check as mandated by RCW 43.43.830-840 is required.

• Must not be listed on the OIG List of Excluded Individuals.

• Must pass a post-offer, pre-employment drug screening.

• A valid state driver's license and proof of insurance are required.

• Excellent communication and interpersonal skills are necessary.

• Detail-oriented, organized, capable of multitasking, and able to thrive in a fast-paced environment.

• Ability to maintain confidentiality and adhere to HIPAA, PHI, security, health and safety, and company policies.

• Regular attendance is required; ability to rotate to other shifts and locations as necessary.

🏝️ Benefits

• This is a remote position.

• Work schedule is Monday through Friday.

• Training hours are from 8 AM to 5 PM Monday through Friday PST.

• Attendance at quarterly quality assurance meetings is expected.

• Opportunities for continuing education through professional journals and approved seminars are provided.