Job Details

The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/ NCD and medical necessity rules. Nature and Scope The Insurance and Claims Specialist is responsible for: Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission. Audit denials and payment variances to determine roo...Claims Specialist, Insurance, Claims, Specialist, Healthcare