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