Health Specialist Jobs

About The Position

Requirements

• High school diploma or equivalent.
• At least 2 years of healthcare insurance payment posting experience with multiple payors.
• Experience using Electronic Medical Record (EMR) systems.
• Ability to navigate insurance payor websites and portals and interpret Explanation of Benefits (EOBs).
• Working knowledge of healthcare terminology, medical procedure coding, reimbursement, and adjustments.
• Proficiency in Microsoft Office 365, especially Excel.
• Strong organization, attention to detail, time management, and written and verbal communication skills.

Nice To Haves

• Experience in healthcare accounts receivable follow-up, denial management, appeals, and underpayment resolution.
• Experience working with multiple commercial and government insurance payors.
• Ability to independently manage assigned worklists and complex claim issues.

Responsibilities

• Process accounts receivable transactions, including insurance payments, adjustments, and account corrections.
• Review assigned insurance claims to determine appropriate reimbursement based on payor requirements.
• Monitor outstanding balances, prioritize aging accounts, and maintain accurate account records.
• Follow up with insurance carriers to verify claim status and facilitate reimbursement.
• Review patient accounts and pursue claim corrections, adjustments, reconsiderations, and appeals as appropriate.
• Investigate denied, rejected, or underpaid claims and resolve discrepancies.
• Use payor portals to research claim details, payment status, and reimbursement requirements.
• Document follow-up activities and resolution steps accurately and promptly.
• Communicate with insurance representatives about claim inquiries and payment discrepancies.
• Work with patients and clinic teams to obtain missing information and correct claim details.
• Respond to documentation requests and collaborate with revenue cycle colleagues to address recurring issues.