What are the responsibilities and job description for the Insurance Recertification Specialist position at Private Label Staff?
Job Summary
The Insurance Recertification Specialist ensures accurate processing of patient orders through internal systems, facilitating seamless insurance billing. This role is crucial in maintaining compliance with insurance guidelines, streamlining workflows, and avoiding delays in patient care.
Key Responsibilities
- Task orders across internal systems such as Salesforce, Brightree, and Oracle.
- Monitor and maintain patient order queues to ensure timely processing.
- Verify insurance coverages, including Medicare, Medicaid, and Commercial Insurance.
- Coordinate with patients, healthcare providers, and insurance companies to gather necessary documentation and approvals.
- Ensure compliance with Medicare LCD (Local Coverage Determination) requirements and payer-specific guidelines.
- Analyze and report daily, weekly, and monthly data.
- Maintain accurate and HIPAA-compliant medical records.
- Identify process improvement opportunities to enhance workflow efficiency.
- Collaborate with cross-functional teams to resolve issues and support departmental projects.
Knowledge, Skills, and Abilities
- Basic knowledge of Medicare, Medicaid, and Commercial Insurance processes.
- Proficiency with Brightree, Salesforce, and Oracle systems (preferred).
- Strong communication, problem-solving, and organizational skills.
- High attention to detail and the ability to multitask in a fast-paced environment.
- Familiarity with medical billing and DME respiratory device guidelines (preferred).
Qualifications
- High School diploma or equivalent (required); some college or medical billing certification (preferred).
- 0–2 years of experience with insurance billing and documentation.
- Beginner proficiency with Microsoft Office and related systems (highly preferred).
