Insurance Specialist 3 (Remote, Hawaii Time Zone)

Job description

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. This is a REMOTE within US Only (Hawaii Time Zone) About this position: Location: Remote within US Only - must work in Hawaii Time Zone). Required Schedule: Monday - Friday 7:30 AM - 4:00 PM (HI - Hawaii Time Zone) Duties include but not limited to: Resolving complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF) or intermediate care facility (ICF) claims. Preparing and submitting claims to Medicare, Medicaid, and private insurers; ensuring compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements); verifying coverage and eligibility; and resolving claim denials or discrepancies. Coordinating with clinical, admissions, and finance teams to ensure accurate documentation, maintaining patient billing records, and optimizing reimbursement through proper coding and timely claim submission. Possessing knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential. Identifying and reporting trends found during the account resolution process such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, no claim on file. Performing financial account assessment functions including but not limited to adjustments and determining balance to patient. Working within client systems to complete rebill functions. Performing administrative functions including but not limited to medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests and approve for client assistance or correct the bill within client platform, review and submit payment verification assistance requests. Maintain familiarity with client preferences and known issues across multiple client accounts. Support special projects for clients as needed. Other duties as assigned. QUALIFICATIONS: High School Diploma or equivalent 5+ years relevant industry experience in registration, billing, collections, required 3+ years' experience with LTC and/or SNF claims resolution, required Knowledge of UB04 claim forms, EOB’s and medical records required ICD-9, ICD-10, CPT and HCPCS coding knowledge required Ability to conduct detailed research to resolve complex claims Intermediate mathematics skills (addition, subtraction, ability to identify trends, etc.) Ability to compile and summarize data Strong verbal and written communication skills Ability to analyze and interpret complex documents, contracts, notes, and other correspondence Ability to prioritize and multitask in a fast-paced environment Ability to work effectively in a remote environment Investigative mind set to identify issues and implement solutions. What we offer: Competitive Hourly Salary Medical/Dental/Vision Insurance Equipment provided 401k program Accrued PTO - 80 hours annually Paid Paternity & Maternity leave programs 9 paid annual holidays Tuition reimbursement Professional growth and much more! PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.