Insurance Specialist - Temp

The US Oncology Network•Antioch, CA

1d•Onsite

About The Position

The Insurance Specialist investigates aged insurance claims to determine payment status and appropriate resolution, using account notes, health plan websites, and health plan customer service. The role determines and facilitates appropriate claim action and financial responsibility through Division of Financial Responsibility (DOFR) information, IPA contacts, and health plan contacts. It maintains timely follow-up so claims are corrected, rebilled, or appealed within carrier filing limits, and records activities in EPM systems. The specialist also helps identify aged-claim patterns and potential process improvements, while managing multiple tasks and changing priorities. The position maintains assigned insurance follow-up work queues, resolves denials and payment issues, documents claims and collection activities, and collaborates with supervisors, practitioners, carriers, and teammates. It meets an average daily target of 35–40 claims and maintains spreadsheets assigned by the Supervisor. Work is performed in an office environment with frequent staff contact and regular direct contact with patients in a clinic setting.

Requirements

High school diploma or equivalent required.
1–2 years of medical office or hospital billing experience required.
1–2 years of experience with CPT/ICD-10 guidelines and use of modifiers required.
1 year of experience with Excel and other Microsoft Office applications required.
1 year of EMR knowledge required.
Strong Microsoft Office capabilities, including Word, Excel, and Outlook.
Ability to work well in a team environment and follow protocols and workflows.
Ability to multitask in a fast-paced work setting with multiple technology platforms.

Nice To Haves

2 years in Business Administration, healthcare, or a related field preferred.
Certified Medical Reimbursement Specialist (CMRS) preferred.
Certified Medical Insurance Specialist (CMIS) preferred.
1–2 years of EPIC EMR experience preferred.
1–2 years of Division of Financial Responsibility (DOFR) experience and training capability preferred.
Insurance follow-up experience; multispecialty experience preferred.

Responsibilities

Maintain timely follow-up on outstanding insurance claims in appropriate EPIC Work Queues, ensuring claims are billed or rebilled within carrier filing limits.
Take appropriate action on claim denials and follow up on rebilled, corrected, and appealed claims to support prompt resolution.
Document claims and collections activities in software systems, including rebills, follow-up, and related correspondence with carriers and practitioners.
Contact healthcare insurers, affiliates, and providers to resolve contract or payment questions.
Inform the Supervisor about issues involving insurance payments or denials and contract pricing, and work with the Supervisor and relevant parties toward resolution.
Meet an average daily accounts-receivable target of 35–40 claims.
Collaborate with leadership and team members to improve or challenge processes, provide trend and solution insights, and support team capability development.
Maintain spreadsheets assigned by the Supervisor.
Investigate aged insurance claims and determine payment status and appropriate resolution using account notes, health plan websites, and health plan customer service.
Use DOFRs, IPA contacts, and health plan contacts to determine and facilitate appropriate claim action and financial responsibility.
Help identify patterns in aged claims and potential process improvements.
Manage multiple tasks and changing priorities in a fast-paced setting using multiple technology platforms.