Insurance Analyst

The SSI Group, LLC.•Mobile, AL

1d•Onsite

About The Position

Responsible for managing medical insurance claims, billing processes, and data entry to ensure accurate reimbursement, compliance with healthcare regulations, and resolution of claim discrepancies. This role involves submitting claims, handling denials, verifying patient insurance, and maintaining accurate records.

Requirements

Experience in healthcare billing or revenue cycle management, with a solid understanding of insurance processes and claim handling.
Strong analytical and problem-solving abilities.
Knowledge of insurance terminology, healthcare regulations, and payer-specific guidelines.
Familiarity with billing software and electronic health record (EHR) systems.
Excellent communication skills, both written and verbal.
Attention to detail and ability to prioritize tasks in a fast-paced environment.
Proficiency with Microsoft Office suite.
Must be able to see clearly with or without corrective lenses and hear clearly with or without aids.
Must be able to use hands, fingers and wrists, repetitively, using a computer keyboard and other office equipment, regularly.
Must be able to proficiently speak, read and write in English.
2+ years of experience with medical billing required.
High school diploma or equivalent required.

Nice To Haves

Associate’s degree in Healthcare Administration, Business, or a related field preferred.

Responsibilities

Process, review and submit insurance claims to third-party payers (Medicare, Medicaid, private insurers) based on medical coding, billing data, and patient insurance information.
Ensure that claims are complete, accurate, and compliant with payer-specific rules and guidelines.
Investigate and analyze denied claims, identifying the cause of denials (e.g., coding errors, missing documentation, eligibility issues).
Work with coding and clinical teams to resolve issues and resubmit claims for payment.
Appeal denied claims and work to ensure that payments are received promptly.
Review insurance company remittance advice (EOBs) to confirm payments are consistent with the terms of the payer contract.
Resolve discrepancies between billed amounts and paid amounts, ensuring accurate adjustments and patient responsibility.
Communicate with payers to resolve any outstanding payment issues.
Ensure proper verification of patient insurance eligibility and benefits prior to service delivery.
Confirm that required pre-authorizations or referrals are obtained for specific procedures, treatments, or hospital admissions.
Track and report on key performance indicators (KPIs) related to claims processing, such as claim approval rates, denials, and aged accounts.
Generate reports to identify trends in claims issues, payer performance, and payment delays.
Post insurance and patient payments accurately into billing systems and reconcile transactions to ensure proper allocation.
Stay up-to-date with changes in healthcare regulations, payer policies, and billing codes (ICD-10, CPT, HCPCS).
Ensure that the department remains compliant with federal, state, and payer-specific billing requirements, including HIPAA.
Assist patients and other stakeholders with insurance-related inquiries, helping to explain coverage issues, billing questions, or denials.
Other duties as assigned