Insurance Specialist

STARFISH FAMILY SERVICES INC•Inkster, MI

2d•Onsite

About The Position

The Insurance Specialist is responsible for managing patient insurance processes to ensure accurate coverage verification, claims processing, reimbursement, and compliance. This role serves as a key liaison between patients, providers, and payers while supporting revenue cycle operations, resolving billing issues, and maintaining accurate insurance records.

Requirements

Associate degree required in Healthcare Administration, Medical Billing & Coding, Business Administration, or related field
Minimum of 2 years of experience in healthcare insurance, billing, or revenue cycle experience required
Direct experience with Medicaid billing and insurance verification is required
Experience with managed care, commercial insurance, provider credentialing, and denial management required
Must have knowledge of ICD-10/CPT coding, payer guidelines, and electronic billing systems
Knowledge of medical billing, insurance processes, and revenue cycle operations
Understanding of payer guidelines, authorizations, and claims adjudication
Strong attention to detail and accuracy
Problem-solving and analytical skills
Effective communication and customer service skills
Ability to manage multiple priorities in a fast-paced environment
Valid driver’s license and / or reliable transportation

Nice To Haves

Bachelor’s degree preferred

Responsibilities

Explain insurance coverage, benefits, and policy terms to patients
Assist patients with questions regarding insurance, billing, and payment options
Set up payment arrangements for self-pay patients and provide financial guidance
Serve as a liaison between patients, providers, and insurance companies to resolve issues
Verify patient eligibility, benefits, and authorization requirements prior to services
Maintain and update patient insurance information in the electronic health record
Ensure all providers are linked to appropriate payer contracts for accurate billing
Support payer enrollment activities, including credentialing, re-attestation, and updates
Maintain accurate tracking of provider enrollment status across all contracted health plans
Review, submit, and track insurance claims to ensure timely reimbursement
Post payments and adjustments from payers to patient accounts
Monitor claims for errors, rejections, or delays and take corrective action
Coordinate and process claim appeals and denial management activities
Work credit balance accounts and ensure appropriate resolution
Denial trend tracking and reporting
Collaborate with insurance payors to resolve denials, underpayments, and billing discrepancies
Identify and resolve patient billing questions and account issues
Maintain records of billing, claims, payments, and settlements
Ensure all processes comply with HIPAA and applicable federal, state, and payer regulations
Maintain confidentiality of patient and financial information
Monitor payer requirements and ensure adherence to contract terms and billing guidelines
Maintain accurate and up-to-date records in billing and insurance systems
Process renewals, updates, and documentation with strong attention to detail
Track and report on claim status, denials, and reimbursement trends
Assist with audits by providing documentation and ensuring data accuracy
Assist with front-end credentialing and privileging providers and clinic locations
Communicate with payers, underwriters, and provider offices to resolve enrollment and billing issues
Monitor and maintain insurance contracts and payer relationships
Ensure timely completion of credentialing and enrollment to prevent billing delays
Identify trends in denials, billing errors, or delays and recommend process improvements
Participate in workflow improvements to enhance efficiency and accuracy
Support implementation of best practices in billing, coding, and insurance processes