Customer Experience Administrative Insurance Specialist

Suncoast Center • St. Petersburg, FL

5h • Onsite

About The Position

The Customer Experience Administrative Insurance Specialist position is based at a Community Mental Health Agency in Pinellas County. This role requires a strong background in behavioral health or medical office settings, with expertise in front desk operations, billing, and customer service. The specialist will be responsible for managing daily, weekly, and monthly Avatar reports related to agency-wide admissions, guarantor set-up, and insurance changes. Key duties include answering client phone calls, updating client accounts, addressing finance/billing issues, and coordinating with authorization specialists to ensure timely processing. The role also involves monitoring reports to verify client financials, completing insurance verification, and ensuring accurate guarantor set-up. The specialist will work with Medicare, Medicaid, and third-party outpatient insurance claims, addressing denials, investigating coding issues, and ensuring overall billing compliance to maximize revenue. This position emphasizes teamwork, cultural competence, strong organizational skills, and the ability to work effectively in a fast-paced, changing environment.

Requirements

• Minimum of an Associate’s Degree required.
• Two years of experience in a behavioral health or medical office setting with experience in front desk operations, billing, and customer service required.
• Three years or more experience in a healthcare setting.
• Knowledge of admission requirements in a healthcare setting.
• Exceptional knowledge of NetSmart Avatar or other electronic medical records.
• Experience working with Medicare, Medicaid and third party outpatient insurance claims and denials utilizing an EHR.
• Knowledge of ICD-10CM, CPT and HCPCS, including coverage levels, rules/regulations, fee schedules and contracted services.
• Demonstrated understanding of quality assurance and monitoring of reports.
• Ability to work autonomously while maintaining proactive communication with supervisor and other departments.
• Ability to demonstrate strong organizational skills.
• Excellent customer service abilities.
• Excellent written and verbal communication skills.
• Cultural competence skills.
• Ability to work effectively with a multi-disciplinary team in a fast-paced, changing environment.
• Must be 21 years of age or older.
• Negative Drug Screening prior to hire and throughout employment.
• Clear Criminal Background Check throughout employment with Suncoast Center and local checks prior to hire and annually along with DCF Level II prior to hire and as required by DCF.
• Must have valid Florida Driver’s License.
• Motor Vehicle checks prior to hire and annually with acceptable driving record maintained throughout employment.
• Reliable vehicle, valid registration, and valid vehicle insurance.
• Proficient with Microsoft Word, Outlook, and Excel.
• Proficient with electronic medical record systems including admissions, financial enrollment, and website portal navigation.
• Electronic Health Record comprehension.
• The ability to function and operate as a team player, showing dignity and respect for all.
• The ability to comply with all equal employment opportunity and ethical standards and regulations.
• The ability to take direction in a respectful and productive manner from supervisors and managers.
• The ability to work, as scheduled, in a timely fashion, and with an attitude oriented to service.
• The ability to have cordial and professional relationships both within the organization and with vendors, clients and third parties.
• If appropriate, the ability to produce all appropriate paperwork and reports consistent with contractual, state or federal standard, and to prepare and submit such paperwork on a timely basis.
• The ability to understand and comply with Suncoast Center, Inc. policies and procedures.
• The ability to render compassionate care and equal commitment to serve clients in need of healthcare assistance.

Nice To Haves

• NetSmart Avatar experience a plus.

Responsibilities

• Complete all daily, weekly, and monthly Avatar management reports related to agency-wide admissions, guarantor set-up, and insurance changes.
• Answer client phone calls, updating client accounts and addressing client issues regarding finance/billing issues.
• Work closely with Authorization specialist to ensure authorizations are processed in an accurate and timely fashion.
• Monitor reports daily, weekly, monthly related to admissions, guarantor/insurance changes to correct/verify client financials: ensuring accuracy.
• Complete and monitor client insurance verification to ensure accurate guarantor set-up during the enrollment period and update periods when required.
• The Reimbursement, Central Intake, Enrollment, and Utilization Departments work together to ensure client information is entered and updated for all clients in the electronic medical record system (Avatar).
• Coordinate with the department managers in the screening, and interviewing of new hires for the department.
• Work as a cohesive team member focused on a common goal to ensure accuracy of the insurance information to maximize revenue.
• Other duties may include data entry of insurance data, addressing denied or rejected claims, investigating coding issues, updating client records and making sure of overall billing compliance in line with insurance guidelines and regulations.
• Participate in access, billing, and other system coordination meetings as needed.
• Work as a cohesive team member focused on a common goal.
• Other Duties as Assigned

Benefits

• Medical, dental, and vision insurance with 0 copy for Teledoc Appointments
• EAP Supports
• Company Paid Basic Life, Accidental Death and Dismemberment, and Long term Disability
• Options to secure additional Life/AD&D as well as short term disability
• Paid time off + 10 company paid holidays
• Professional development options through our Learning Management System and live trainings
• 403b with up to a 5% company match
• Monthly Social Committee Events

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 101-250 employees