Insurance Claims Specialist PB

About This Opportunity

We are representing a major healthcare system in their search for an Insurance Claims Specialist. Our client operates multiple hospital facilities and is seeking a detail-oriented professional to manage patient account balances, ensure compliant claim submission, and support revenue cycle excellence. This is a full-time, non-exempt position offering stability within a large healthcare organization.

Responsibilities

• Submit accurate and timely claims to third-party payers while resolving claim edits and account errors prior to submission
• Follow up with third-party payers according to established procedures and timelines to ensure collections and exceed departmental goals
• Contact payers to resolve unpaid claims and utilize payer portals and websites to verify claim status and conduct account follow-up
• Comply with HIPAA regulations and privacy practices pertaining to PHI and all claim submission and follow-up activities
• Assist Patient Access and Care Management teams with denials investigation and resolution
• Research and process mail returns and claims rejected by payers, reconciling billing account transactions to ensure accuracy
• Monitor accounts to facilitate timely follow-up and payment to maximize cash receipts while maintaining work queue volumes within established guidelines
• Gather statistics, complete reports, and perform clerical duties as scheduled or requested
• Provide excellent customer service to patients, visitors, and employees while maintaining strict confidentiality
• Participate in performance improvement initiatives and work with leadership to develop and exceed annual goals

What We're Looking For

Required:

• High school diploma or equivalent
• Excellent oral and written communication skills
• Working knowledge of computers and ability to operate keyboards, fax machines, telephones, and other business equipment
• Excellent customer service and telephone etiquette skills
• Ability to use tact and diplomacy when dealing with others
• Ability to sit for extended periods and communicate effectively
• Visual acuity within normal range and strong reading comprehension ability

Preferred:

• One year of medical billing or medical office experience
• Knowledge of medical terminology
• Knowledge of business math
• Knowledge of ICD-10 and CPT coding processes
• Understanding of revenue cycle operations, third-party reimbursement, payer relations, claims adjudication, and contractual claims processing

How We Work With You

When you apply through Get A Job.ai, our recruiting team will review your qualifications and conduct an initial screening. If there's a strong match, we will submit your profile to our client for consideration. Please do not contact the hiring organization directly—all communication should flow through our talent team to ensure the best experience for everyone involved.

Pay

Compensation details will be discussed during the screening process based on experience and qualifications.

Get A Job.ai is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all candidates and employees.