Insurance Reimbursement Specialist

Aspira Labs, Inc.•Shelton, CT

6h•Onsite

About The Position

As an Insurance Reimbursement Specialist, you will work with insurance and billing companies to process medical reimbursements for patients. Your primary duties include claim review, appeal generation, interacting with patients, communicating with insurance providers, assist with retrieving EOBs, and other duties as assigned. To be successful in this role, you need strong analytical, communication, and organizational skills.

Requirements

College degree preferred or equivalent but will substitute for applicable work experience
Minimum two (2) years’ experience in healthcare accounts receivable environment; knowledge of medical terminology, billing, and coding a plus
Demonstrate proficiency in Microsoft Word and Excel
Adhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI information
Exceptional analytical and organizational skills
Ability to work independently, a team player with strong interpersonal skills to effectively interact with all levels of employees
Superior time management and critical thinking skills
Ability to work under pressure and achieve goals efficiently
Strong written and verbal communication skills
Dependable, flexible, and adaptable in all aspects of work

Responsibilities

Responsible for submission of appeals to national payers
Provide review of all levels of an insurance appeal
Gather supporting documentations (physician medical records, patient /physician letters etc.)
Work incoming correspondence from payors to assist with claim appeal
Interact with utilization review/management departments
Assist with gathering EOB’s if cash poster is unable to locate
Provide excellent customer service via the handling of inbound and outbound calls/emails to patients and providers
Data Entry
Assist with Error Processing when business volume dictates the need
Review claim denials within 1 week of posting to determine next step for accession
Submit request to provider for necessary documentation for appeal- follow up on requests within 2 weeks if not received.
Submit accessions for adjustments per Patient Transparency Program guidelines and document accession to reflect need for adjustment accurately
Follow up with plans when trends of nonpayment or incorrect payment is received per contracts
Utilize portals/fax/USPS to submit appeals for claim review when necessary. USPS should be last resort if portal/Fax unavailable
Provide payor status updates when issues arise to leadership
Review Sfax for documentation relating to payor groups daily
Review correspondence at the time of working denials to verify if we received essential information for the claim.
Provide response to patient and client emails/voicemails within 24 business hours of receipt and document account appropriately
Adherence to schedule
Productivity based on accuracy and quality
Maintain a positive, achievement-oriented attitude and influence others to do the same
Demonstrate high ethical standards and personal integrity
Display a commitment to personal growth