Medical Insurance Claims Specialist

You will also have the responsibility of ensuring clean claim submission and providing accurate estimates to patients. This role offers a contract to permanent employment opportunity.

• Manage and investigate insurance coverage related issues and coordinate with team members for necessary follow-ups
• Act as a resource for patients, staff, and management, providing necessary guidance and support
• Maintain updated information related to benefits and coverage, ensuring compliance with internal policies and procedures
• Verify benefits in accordance with regulatory guidelines and internal policies
• Prepare necessary reports for team members and management, facilitating informed decision-making
• Communicate effectively with patients, providing them with accurate estimates and discussing payment options
• Alert patients and staff about any coverage changes or insurance policy issues that might affect reimbursement or patient responsibility
• Obtain necessary documentation such as additional member information, letters of medical necessity, authorizations, referrals etc., to secure reimbursement
• Ensure clean claim submission by resolving issues relating to insurance verification that may negatively impact reimbursement
• Conduct audits and maintain track of accounts due for insurance verification, authorizations, referrals, and date of service collections. • Proven experience in Accounts Receivable (AR) within a healthcare setting
• Familiarity with the Appeals process, preferably within a medical insurance context
• Proficiency in handling Billing Functions, with a focus on accuracy and timeliness
• Demonstrated expertise in Claim Administration, ensuring all claims are processed effectively
• Knowledge of Collection Processes, with the ability to negotiate and resolve payment issues
• Exceptional Customer Service skills, with a commitment to providing a high standard of care and support to patients and their families.