Insurance Claims Specialist

3 days ago

Naples, Florida, United States SCA Health Full time
Job Summary

We are seeking a highly organized and detail-oriented Insurance Specialist to join our team at SCA Health. As an Insurance Specialist, you will be responsible for ensuring prompt and accurate credit balance research of patient accounts, processing refunds and initiating insurance check refunds requests, and sending overpayment letters to carriers. You will also review and validate written requests received from insurances, submit payer disputes as needed, and answer calls and inquiries from third-party carriers.

Responsibilities
  • Assure prompt and accurate credit balance research of patient accounts
  • Process refunds and initiate insurance check refunds requests in Accounts Payable system
  • Send overpayment letters to carriers that have overpaid per contract
  • Review and validate written requests received from insurances
  • Submit payer disputes as needed
  • Answer calls and inquiries from third-party carriers
  • Follow up on all outstanding credit accounts
  • Calculate and verify expected pay based on contractual allowances for multiple payers
  • Document all work performed in patient accounting system
  • Review patient account history and notes to determine next step required for resolution per company guidelines
  • Process contractual adjustment requests as needed to correct account balances
  • Promptly process all government refunds within timelines
  • Run monthly credit reports to verify that checks issued have been posted
Requirements
  • Excellent telephone skills and customer service skills
  • High level of self-organization and tracking
  • Works independently, is a self-starter with a high level of initiative
  • Strong communication skills, both verbally and in writing
  • Possesses accurate judgment, especially handling insurance claims and dealing with patient accounts
  • Versatile and willing to coordinate with and participate in, when necessary, all other aspects of the Business Office
  • Ability to handle confidential information
  • Possess basic knowledge of medical terminology
  • Possess knowledge of health insurance billing
  • Read and interpret EOBs and can calculate expected allowances based on payer contracts to determine reason for balance
  • Possess knowledge of typing, word processing, spreadsheet, and computer billing systems
  • Must be dependable and reliable
  • Ability to multi-task, think critically, and solve problems
  • One or more years' experience in a related position working in a medical office, hospital, outpatient surgery center, or related field with core duties related to medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements, or related training/certificates/diplomas

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