Senior Insurance Recertification Specialist

Job Summary
The Senior Insurance Recertification Specialist leads complex insurance billing tasks, mentors junior staff, and enhances department workflows. This role ensures accuracy, compliance, and efficiency in managing patient recertifications and insurance processes.

Key Responsibilities

• Task and oversee patient orders across systems like Salesforce, Brightree, and Oracle.
• Monitor patient queues, ensuring compliance with Medicare LCD and payer-specific guidelines.
• Provide mentorship and guidance to junior team members on insurance processes and workflows.
• Analyze and report on departmental metrics, including productivity and quality benchmarks.
• Coordinate with patients, healthcare providers, and insurers to gather and verify documentation.
• Lead process improvement initiatives to enhance departmental efficiency and compliance.
• Collaborate with management to monitor team production and quality, ensuring KPI achievement.
• Maintain up-to-date patient records and ensure HIPAA compliance.

Knowledge, Skills, and Abilities

• Advanced knowledge of Medicare, Medicaid, and Commercial Insurance guidelines.
• Strong leadership, mentorship, and problem-solving skills.
• Proficiency in Brightree, Salesforce, and Oracle systems.
• Ability to independently manage complex workflows and additional responsibilities.
• Exceptional organizational skills and the ability to adapt in a fast-paced environment.

Qualifications

• High School diploma or equivalent (required); some college or medical billing certification (preferred).
• 2–4 years of experience with insurance billing and recertifications, including DME respiratory devices.
• Advanced proficiency with Microsoft Office and internal tasking systems (preferred).