Insurance Claims Specialist II

5 days ago


Pittsburgh, Pennsylvania, United States Riverside Health System Full time

Job Summary

The Insurance and Follow-Up Specialist II plays a critical role in ensuring timely follow-up of facility claims for all acute care locations. This position is responsible for managing assigned portions of accounts receivable and aging reports, responding to insurance company requests for information, and identifying issues. The successful candidate will also assist with coaching and training staff.

Key Responsibilities

  • Manage assigned portion of AR and work aging reports to ensure timely follow-up of facility claims.
  • Review accounts to ensure proper reimbursement of claims and report any problems, issues, or trends to management.
  • Research and write appeals to insurance companies on denied accounts and resubmit applicable claims within 24 hours of receipt.
  • Respond to insurance company requests for information and process insurance/patient correspondence within 48 hours of receipt.
  • Meet productivity and QA standards set by management.
  • Assist with coaching and training of staff.
  • Perform other tasks and special projects as needed.

Requirements

  • High School Diploma or GED (Required)
  • Bachelor's Degree in Accounting, Finance, or related field (Preferred)
  • 3-4 years of insurance follow-up experience (Required)
  • CRCR - Healthcare Financial Management Association (HFMA) certification within 1 year (Required)

About Riverside Health System

Riverside Health System is a leading healthcare provider in the region, dedicated to delivering high-quality patient care and exceptional service. We are committed to creating a work environment that values diversity, inclusion, and teamwork.



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