The Appeals Specialist is responsible for performing insurance follow-up activities, including claim submission, status inquiries, and filing appeals for denied claims. They must accurately process high volumes of account data while maintaining HIPAA compliance and supporting collection efforts.
Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while thriving in a fast-paced environment. Key Responsibilities
Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims.
Process a high volume of detailed account information accurately and within established performance guidelines.
Navigate multiple systems to obtain insurance, contact, and attorney information as needed.
Support the prioritization of collections efforts by accurately updating account data and identifying next steps.
Maintain the highest level of confidentiality and adhere to all HIPAA regulations.
Apply hospital billing knowledge to carry out assigned duties efficiently.
Essential Duties
Complete insurance-related tasks such as correcting and resubmitting claims, filing appeals, and contacting insurance companies, attorneys, or patients regarding outstanding balances.
Work assigned facility-specific queues, ensuring all accounts are updated with correct and complete information.
Participate in special projects or assignments as directed.
Assist colleagues and management by providing information or support related to insurance processes when needed.
Qualifications
3-5 years of experience in a healthcare setting such as a hospital business office, surgery center, physician practice, or health insurance organization.
Strong communication skills, attention to detail, and self-motivation.
Proficient knowledge of insurance processes, including claim submission, claim denials, HCPCS/CPT/ICD-10 coding basics, and claim status inquiries.
Familiarity with Medicare/Medicaid, Commercial, Auto, Workers’ Compensation, Liability, Crime Victims, and State/Federal Insurance Programs.
Experience with medical billing and collection practices, business office procedures, and multi-system computer navigation.
Ability to type at least 55 words per minute.
High School Diploma or GED required; some college preferred.
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