About the position Insurance Specialists are highly focused on the resolution of insurance processing errors and denials and work to resolve hospital and physician billing challenges. You will utilize your expertise in patient billing, claims submission, and payer guidelines (Medicare, Medicaid, &, commercial insurers) to effectively work with insurance companies, resolve issues, and ensure accurate and timely payments.

Responsibilities

• Reduce outstanding accounts receivable by managing claims inventory 
• Speak to patients and insurance companies in a professional manner regarding their outstanding balances 
• Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for services 
• Request, input, verify, and modify patient’s demographic, primary care provider, and payor information 
• Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc. 
• Answer questions by phone and provide quotes for services; identify financial resources, etc. in accordance with the client policies and procedures 
• Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc. 
• Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies 
• Work with Claims and Collections in order to assist patients and their families with billing and payment activities

Requirements

• High School Diploma/GED
• 3+ years of Denials Management experience
• 2+ years Medical Billing/Follow-up experience
• Medicare, Medicaid, and commercial payor experience
• Experience with Professional Billing and CMS-1500
• Proficiency with PC-based applications (Microsoft Outlook, Word, and Excel)
• Download speed of 30MB or higher & upload speed of 10MB or higher are REQUIRED. (you can test your speed here: https://speedtest.net/ )
• Access to a Secure and Private workspace (a space in which no one can hear or see you as you may have protected health information on your screen or you may say names, social security numbers or other PHI)
• Must be legally authorized to work in the United States without sponsorship
• As a condition of employment, a pre-employment background check will be conducted

Nice-to-haves

• Experience using Epic EHS platform
• Knowledge of CA payers (including Medi-Cal)

Benefits

• Comprehensive paid training
• Medical, dental, and vision insurance
• HSA and FSA available
• 401(k) with company match
• Paid Wellness Time and Holidays
• Employer paid life insurance and long-term disability
• Internal growth opportunities