Job Description

Position Overview

Ultimate Staffing Services is actively seeking a detail-oriented Medical Insurance Collections Specialist to join their client's team in Florida. This role is crucial in managing the collection of outstanding insurance balances, ensuring timely reimbursement of claims, and maintaining compliance with federal and state regulations. The specialist will collaborate with insurance carriers, patients, and internal departments to secure payment for medical services rendered, playing a key part in the organization's revenue cycle.

Responsibilities

• Perform timely follow-up on unpaid or underpaid insurance claims via electronic systems, phone calls, or written correspondence.
• Research and resolve insurance claim denials, rejections, and underpayments.
• Submit corrected claims, appeals, or supporting documentation as required by payer policies.
• Track and document the status of outstanding claims and actions taken using the organization's billing software and/or EMR.
• Analyze Explanation of Benefits (EOBs), remittance advices, and payer correspondence to determine proper payment posting and identify discrepancies.
• Ensure accurate and thorough account documentation for audit and compliance purposes.
• Reconcile insurance payments against billed amounts to detect errors, duplications, or inappropriate adjustments.
• Communicate professionally with insurance companies, patients, and internal teams to clarify billing issues and resolve account concerns.
• Coordinate with coding, billing, and patient services staff to resolve complex account issues.

Qualifications

• Solid understanding of medical insurance including deductibles, copay, and coinsurance is highly preferred.
• Experience with verifying and interpreting medical benefits for Medicare, Medicaid, and major commercial health insurance and secondary payers required.
• Experience processing provider referrals and prior authorization requests.
• Understanding of medical terminology and ICD-10 codes and diagnosis.
• Familiar with individual payer guidelines and authorization/referral requirements based on insurance plans; able to communicate with insurance companies via phone and/or website to provide any supporting clinical documentation needed to complete the authorization process.
• Ensure complete and accurate information maintained in patient accounts including authorization or referral received from payer or Primary Care Physician.
• Strong people skills required; diplomatic, patient, flexible, and able to multi-task and be cross-trained on all functions within the Insurance Verification Department.
• Must be mobile in an office setting, sitting, standing, walking, and bending.
• Perform general duties and other functions as required or assigned.
• Working knowledge of Microsoft Suite including Excel, Word, Outlook.

Required Work Hours

Monday - Friday, 1st shift

Benefits

Competitive pay with a range of $19 to $22 per hour, based on experience and qualifications.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county , to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.

Job Tags

Hourly pay, Work at office, Local area, Flexible hours, Day shift, Monday to Friday,

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