Insurance Specialist

About Us

Our mission is to support clients in surpassing their financial health objectives. Through the entire reimbursement cycle, our scalable solutions combined with clinical expertise effectively address programmatic needs. Our team leverages advanced technology and analytics to drive solutions and maintain accountability toward achieving goals.

We are committed to building enduring careers by investing in your professional growth and personal development, believing your achievements reflect our success.

Job Summary

The Insurance Specialist role involves reviewing and resolving outstanding insurance balances associated with hospital or physician patient accounts. The position requires adaptability in learning complex hospital systems and strong analytical skills to determine optimal approaches for resolving aged receivables. The specialist is accountable for meeting cash recovery targets and ensuring assigned hospital receivables comply with company, client, and federal policies.

Key Responsibilities

• Manage assigned insurance receivables to meet business line expectations effectively.
• Maintain productivity standards outlined by the business line.
• Achieve at least 85% accuracy and quality score on all account work.
• Conduct timely follow-ups on accounts to prevent cash loss.
• Attain monthly cash recovery goals for assigned client receivables.
• Resolve insurance accounts within 90 days following placement.
• Prioritize workload with minimal supervision to meet objectives.
• Research accounts and route them appropriately within client workflows.
• Navigate and analyze client host systems to perform account research.
• Demonstrate strong understanding of patient accounting systems to facilitate learning new platforms.
• Document account actions and next steps clearly in patient accounting software.
• Operate Prism system efficiently, understanding claim updates, workflows, and entry of action steps.
• Request documentation as needed based on account requirements and compliance regulations.
• Perform basic claim billing functions within billing systems.
• Prepare insurance payment appeals as necessary.
• Communicate complex account information clearly.
• Ensure compliance with client standards and federal regulations when managing accounts.
• Maintain high standards of account handling per client guidelines.
• Adhere to federal, state, departmental, and compliance policies.
• Keep accurate, concise records of contact attempts and account activities as per company and client protocols.
• Engage in ongoing education and training to support career and skill development.
• Stay updated with federal and state regulations related to phone calls, collections, HIPAA, FDCPA, Privacy Act, FCRA, and more.
• Attend and apply training and policy updates promptly into daily routines.

Minimum Qualifications & Requirements

• Minimum one year of experience in a healthcare receivables environment.
• High school diploma or equivalent.
• Strong oral and written communication skills.
• Basic computer proficiency with familiarity in patient accounting software.
• Detail-oriented with good data management abilities and problem-solving skills.
• Effective communication with patients, hospitals, insurance companies, and colleagues.
• Capability to work independently and collaboratively within teams.
• Concentration ability for extended periods.
• Good numerical skills and familiarity with administrative procedures.

Physical Demands

Reasonable accommodations may be provided for individuals with disabilities to perform essential job functions. The role requires regular eye-hand coordination and manual dexterity for operating office tools. Extended computer use for 6-8 hours daily and managing frequent interruptions are commonplace. Prolonged sitting is typical, with occasional lifting or moving of items up to 20 pounds. The job may involve heightened stress during busy times with multiple deadlines.

Additional Information

This job description outlines a general guideline for the role and its main responsibilities but is not exhaustive. Additional duties and requirements may be assigned by supervisors as needed.