Insurance Specialist #101455

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Posted: Tue, 16 Jul 2019 10:10:46 -0400

Location: Milford, DE

Industry: Office Call Center

Job Type: Temp/Contract

Skill Set: Entry level (0-2 yrs)

Pay/Rate: 18.00/HOUR


Description:

Insurance Specialist
Contemporary Staffing Solutions has an immediate opening for an Insurance Specialist in Dover, DE. As the Insurance Specialist, you will be responsible for following up on all hospital/professional insurance claims. This is a full-time contract opportunity that will last for about 3 months, possibly longer! 

Responsibilities of the Insurance Specialist include:

  • Follows up on unpaid claims and appeals via telephone or web based claim inquiries. 
  • Verifies insurance eligibility, corrects claim errors, submits claim re-considerations, writes appeals and provides requested information to resolved denied claims.  Interacts with various long term care offices to correct denials as appropriate. 
  • Refers denied claims to correct department work queue as needed to resolve the denial; resubmits denied claims with revised information.   
  • As applicable, converts denied inpatient admissions to observation claims based on insurance company approving observation.
  • Completes imaging system correspondence work queue(s) as appropriate.
  • Contacts patients to resolve insurance company initiated information requests as needed to facilitate claim payment. 
  • Reviews and interprets Federal and State regulations for Medicare and Medicaid and contract terms for Managed Care, Commercial, and Workers Compensation as applicable. 
  • Reviews insurance company payment variances; pursues underpaid claims and submits overpayments for refunds. 
  • Calculates expected reimbursement for outlier claims and claims with days denied as not medically necessary.  Refers patients for Financial Assistance based on Medicare/Medicaid benefits exhausted and delayed lower level of care placement scenarios. 
  • Processes credit balances; submits overpayments electronically to insurance companies who require electronic submission to correct the overpayment.  As applicable, reviews third party vendor submitted refunds for accuracy. 
  • Identifies and performs appropriate contract and/or other denial related write offs.  Researches missing payments via undistributed work queues and apply payment to correct invoice. 
  • Documents accounts thoroughly and appropriately with all information concerning claim and expected payment status and necessary follow up action taken to secure payment. 
  • Escalates insurance company and internal claim related issues to management as appropriate for resolution.

Requirements:

Requirements of the Insurance Specialist:

  • High School Diploma/GED

  • 3 years' experience in hospital and/or physician billing & collections

  • Medicare background

  • Previous experience utilizing FISS/DE system

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. Originally a staffing agency, we have evolved into a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, Information Technology, and Salesforce. We respect our clients and candidates equally while keeping the client’s best interest in mind. We operate with pro-active pipelines, with the highest business ethics, a winning spirit in our approach, a team-oriented work flow, and with real cross training. The CSS team coaches you with current business intelligence so that we can manage your expectations. It’s what makes CSS great and, most importantly, FUN to work with!


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