Medical Insurance Specialist

About the Role:

The Medical Insurance Specialist plays a crucial role in ensuring that healthcare providers receive timely and accurate reimbursement for services rendered. This position involves managing the complexities of medical insurance billing and claims resolution, which directly impacts the financial health of the organization. The specialist will work closely with patients, insurance companies, and healthcare providers to facilitate smooth communication and resolve any discrepancies. By effectively handling insurance correspondence and patient collections, the specialist contributes to a positive patient experience and supports the overall operational efficiency of the healthcare facility. Ultimately, the goal is to streamline the billing process and minimize delays in payment, ensuring that the organization can continue to provide high-quality care to its patients.

Minimum Qualifications:

• High school diploma or equivalent.
• Proven experience in medical insurance billing and claims processing.

Preferred Qualifications:

• Medical Billing/Coding Experience Required.
• 1-2 years experience in medical office environment,
• Medical Terminology knowledge
• Experience with ICD-10/CPT/HCPCs Coding
• Knowledge of Medical Insurance policies and guidelines
• EHR Experience
• Excellent internal and external customer service

Responsibilities:

• Manage and process medical insurance claims, ensuring accuracy and compliance with regulations.
• Communicate with insurance companies to resolve claims issues and discrepancies.
• Assist patients with understanding their insurance benefits and billing statements.
• Conduct patient collections and follow up on outstanding balances.
• Maintain detailed records of all correspondence and transactions related to insurance claims.

Skills:

The required skills of insurance correspondence and medical insurance billing are essential for daily operations, as they enable the specialist to effectively communicate with both patients and insurance providers. Proficiency in claims resolution is critical, as it allows the specialist to identify and rectify issues that may delay payment. Patient collections skills are utilized to ensure that outstanding balances are addressed promptly, fostering a positive relationship with patients. Attention to detail is paramount in this role, as accurate documentation and record-keeping are necessary for compliance and efficient claims processing. Preferred skills, such as familiarity with healthcare regulations and software, enhance the specialist's ability to navigate the complexities of the insurance landscape.