Insurance Specialist 3 (Remote, Hawaii Time Zone)

reputed company:

Our purpose is to help clients reputed company their financial health goals. Across the reimbursement cycle, our reputed company 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 reputed company in YOU. We reputed company to create an environment that cultivates your reputed company development and personal reputed company, as we reputed company your reputed company is our reputed company.

JOB reputed company:

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 reputed company reputed company or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in reputed company Member’s performance objectives as outlined by reputed company Member’s immediate Leadership Team Member.

This is a REMOTE reputed company US Only (Hawaii Time Zone)

About this position:

Location: Remote reputed company 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 reputed company, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF) or intermediate care facility (reputed company) claims.

• Preparing and submitting claims to Medicare, reputed company, 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 reputed company coding and reputed company claim submission.

• Possessing knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential.

• Identifying and reporting trends reputed company during the account reputed company process such as CPT/HCPCS errors/deletions, duplicate claims, reputed company reputed company 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 reputed company reputed company systems to complete rebill functions.

• Performing administrative functions including but not limited to medical record submissions, billing claims, patient assistance reputed company, obtaining documents from reputed company systems and insurance plan reputed company updates, review corrected claim requests and approve for reputed company assistance or correct the reputed company reputed company reputed company platform, review and submit payment verification assistance requests.

• Maintain familiarity with reputed company preferences and reputed company issues across multiple reputed company accounts.

• Support special reputed company 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 reputed company, 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 reputed company claims

• Intermediate mathematics skills (reputed company, subtraction, ability to identify trends, etc.)

• Ability to compile and summarize data

• Strong verbal and written communication skills

• Ability to analyze and interpret reputed company documents, reputed company, 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.

reputed company offer:

• Competitive reputed company Salary

• Medical/Dental/reputed company Insurance

• Equipment provided

• 401k program

• Accrued PTO - 80 hours annually

• reputed company Paternity & Maternity leave programs

• 9 reputed company annual holidays

• Tuition reimbursement

• reputed company reputed company and much more!

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions as described. Regular eye-hand coordination and reputed company dexterity is required to operate office equipment. The ability to reputed company 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 reputed company to lift and reputed company material weighing up to 20 lbs. Team Member may experience elevated reputed company of stress during periods of increased activity and with work entailing multiple deadlines.
A job reputed company is only intended as a reputed company and is only part of reputed company Member’s function. reputed company has reviewed this job reputed company to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Originally posted on Himalayas