Insurance Specialist

Insurance Specialist

STARFISH FAMILY SERVICES INC - 3.4

Inkster, MI Job Details Full-time 1 day ago Qualifications Insurance verification Managed care Associate's degree Full Job 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