Medical Insurance Specialist

Position Summary

The Medical Insurance Specialist independently submits or takes the necessary actions to resolve rejected or denied insurance claims by performing all collection tasks as assigned utilizing collection processes with a high level of knowledge, skills, abilities, and experience. The follow-up position will assume duties as a collector/denial specialist, to manage patient accounts receivable from the point of resubmission of rejected or denied medical claims through final resolution.

Identify and address denials by writing appeal letters and ensure account balances are correct based on payer contract terms. Works under general supervision from the Revenue Cycle Manager.

Duties

Responsibilities

• Conduct follow-up on unpaid or denied claims to ensure timely and accurate reimbursement.
• Analyze denial reasons and take appropriate action to appeal or resubmit claims.
• Contact payers and utilize online portals to resolve outstanding account balances.
• Collaborate with billing, coding and clinical staff to gather necessary documentation for appeals or corrections.
• Track and document follow-up activities in Epic.
• Quickly identify and solve problems, escalating recurring denial trends or payer issues to reimbursement coding specialist when necessary.
• Responsible to validate the payments and adjustments made on accounts are correct.
• Maintains daily work queues.
• Acts as a liaison between insurance and providers to ensure coverage and benefits are active at the time of billing.
• Identify authorization numbers saved in the system and attach them to our claims as needed for processing.
• Assist with training and continuous education for billing staff to ensure adherence to ethical billing practices.
• Perform other related duties as assigned, including supporting process improvements and serving as a technical resource and duties that are consistent with the lower level of the medical insurance series.