Insurance Specialist

Insurance Specialist

Hiveley Corp - Inkster, MI 48141

Overview

Level Experienced Position Type Full Time Job Shift Day Education Level 2 Year Degree

Description

Position Summary: 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.

Education And Experience: • Associate degree required in Healthcare Administration, Medical Billing & Coding, Business Administration, or related field, bachelor's degree preferred. • 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

Principal Duties And Responsibilities:

Policy And Patient Support: • 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 Insurance Verification And Enrollment: • 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

Claims Management And Billing Support • 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

Revenue And Cycle Support • 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

Compliance And Regulatory Requirements • 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

Administrative And Data Management • 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

Credentialing And Payer Relations • 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 Quality And Process Improvements • 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 Core Competencies • 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

Licensing And Other Requirements: • Valid driver's license and / or reliable transportation.

Starfish Family Services is an Equal Opportunity Employer EOE/M/F/D/V