Job Description
POSITION SUMMARY:
The Insurance Specialist is responsible for managing patient insurance processes to ensure accurate coverage verification, claims processing, reimbursement, and compliance. This role serves as a key liaison between patients, providers, and payers while supporting revenue cycle operations, resolving billing issues, and maintaining accurate insurance records.
EDUCATION AND EXPERIENCE:
• Associate degree required in Healthcare Administration, Medical Billing & Coding, Business Administration, or related field, bachelor’s degree preferred.
• Minimum of 2 years of experience in healthcare insurance, billing, or revenue cycle experience required.
• Direct experience with Medicaid billing and insurance verification is required.
• Experience with managed care, commercial insurance, provider credentialing, and denial management required.
• Must have knowledge of ICD-10/CPT coding, payer guidelines, and electronic billing systems
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Policy and Patient Support:
• Explain insurance coverage, benefits, and policy terms to patients
• Assist patients with questions regarding insurance, billing, and payment options
• Set up payment arrangements for self-pay patients and provide financial guidance
• Serve as a liaison between patients, providers, and insurance companies to resolve issues
Insurance Verification and Enrollment:
• Verify patient eligibility, benefits, and authorization requirements prior to services
• Maintain and update patient insurance information in the electronic health record
• Ensure all providers are linked to appropriate payer contracts for accurate billing
• Support payer enrollment activities, including credentialing, re-attestation, and updates
• Maintain accurate tracking of provider enrollment status across all contracted health plans
Claims Management and Billing Support
• Review, submit, and track insurance claims to ensure timely reimbursement
• Post payments and adjustments from payers to patient accounts
• Monitor claims for errors, rejections, or delays and take corrective action
• Coordinate and process claim appeals and denial management activities
• Work credit balance accounts and ensure appropriate resolution
• Denial trend tracking and reporting
Revenue and Cycle Support
• Collaborate with insurance payors to resolve denials, underpayments, and billing discrepancies
• Identify and resolve patient billing questions and account issues
• Maintain records of billing, claims, payments, and settlements
Compliance and Regulatory Requirements
• Ensure all processes comply with HIPAA and applicable federal, state, and payer regulations
• Maintain confidentiality of patient and financial information
• Monitor payer requirements and ensure adherence to contract terms and billing guidelines
Administrative and Data Management
• Maintain accurate and up-to-date records in billing and insurance systems
• Process renewals, updates, and documentation with strong attention to detail
• Track and report on claim status, denials, and reimbursement trends
• Assist with audits by providing documentation and ensuring data accuracy
Credentialing and Payer Relations
• Assist with front-end credentialing and privileging providers and clinic locations
• Communicate with payers, underwriters, and provider offices to resolve enrollment and billing issues
• Monitor and maintain insurance contracts and payer relationships
• Ensure timely completion of credentialing and enrollment to prevent billing delays Quality and Process Improvements
• Identify trends in denials, billing errors, or delays and recommend process improvements
• Participate in workflow improvements to enhance efficiency and accuracy
• Support implementation of best practices in billing, coding, and insurance processes Core Competencies
• Knowledge of medical billing, insurance processes, and revenue cycle operations
• Understanding of payer guidelines, authorizations, and claims adjudication
• Strong attention to detail and accuracy
• Problem-solving and analytical skills
• Effective communication and customer service skills
• Ability to manage multiple priorities in a fast-paced environment
LICENSING AND OTHER REQUIREMENTS:
• Valid driver’s license and / or reliable transportation.
Starfish Family Services is an Equal Opportunity Employer
EOE/M/F/D/V