Insurance Specialist 3 - Long Term Care Biller (REMOTE - HI)

CorroHealth•HI-Remote, HI

39d•Remote

About The Position

This is a REMOTE position within the US only. The required schedule is 7:30 AM - 4:00 PM Hawaii Time Zone. The role involves resolving complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF), or intermediate care facility (ICF) claims. Responsibilities include preparing and submitting claims to Medicare, Medicaid, and private insurers, ensuring compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements), verifying coverage and eligibility, and resolving claim denials or discrepancies. The position requires coordination with clinical, admissions, and finance teams for accurate documentation, maintaining patient billing records, and optimizing reimbursement through proper coding and timely claim submission. Knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential. The role also involves identifying and reporting trends in account resolution, performing financial account assessment functions, working within client systems to complete rebill functions, and performing various administrative functions such as medical record submissions, patient assistance outreach, and insurance plan code updates. Maintaining familiarity with client preferences and supporting special projects are also part of the role. Other duties may be assigned.

Requirements

High School Diploma or equivalent
5+ years relevant industry experience in registration, billing, collections, required
3+ years' experience with LTC and/or SNF claims resolution, required
Knowledge of UB04 claim forms, EOB’s and medical records required
ICD-9, ICD-10, CPT and HCPCS coding knowledge required
Ability to conduct detailed research to resolve complex claims
Intermediate mathematics skills (addition, subtraction, ability to identify trends, etc.)
Ability to compile and summarize data
Strong verbal and written communication skills
Ability to analyze and interpret complex documents, contracts, notes, and other correspondence
Ability to prioritize and multitask in a fast-paced environment
Ability to work effectively in a remote environment
Investigative mind set to identify issues and implement solutions.

Nice To Haves

Possessing knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential.

Responsibilities

Resolving complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF) or intermediate care facility (ICF) claims.
Preparing and submitting claims to Medicare, Medicaid, and private insurers; ensuring compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements); verifying coverage and eligibility; and resolving claim denials or discrepancies.
Coordinating with clinical, admissions, and finance teams to ensure accurate documentation, maintaining patient billing records, and optimizing reimbursement through proper coding and timely claim submission.
Identifying and reporting trends found during the account resolution process such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, no claim on file.
Performing financial account assessment functions including but not limited to adjustments and determining balance to patient.
Working within client systems to complete rebill functions.
Performing administrative functions including but not limited to medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests and approve for client assistance or correct the bill within client platform, review and submit payment verification assistance requests.
Maintain familiarity with client preferences and known issues across multiple client accounts.
Support special projects for clients as needed.
Other duties as assigned.