Insurance Specialist I

Summary

Supports insurance payment processing and basic account follow-up activities to help ensure accurate posting, documentation, and timely reimbursement. Reviews Explanation of Benefits (EOBs), remittance advice, electronic deposits, and paper checks for accurate payment application.

Performs routine account maintenance, basic insurance research, and assigned follow-up tasks under guidance. This is an entry to early-career role with narrower responsibility and less independent judgment than Insurance Specialist II.

Must have basic knowledge of medical insurance billing processes and be able to perform routine payment posting and account review functions accurately.

Basic understanding of medical billing practices, debits and credits, and third-party payer processes is required. Ability to learn practice management and EHR systems used by ENA is required.

• High school diploma or equivalent.


• 1 year of directly related medical insurance, billing, payment posting, or medical office revenue cycle experience preferred.


• Equivalent combination of closely related education and experience may be considered.


• Basic proficiency in Microsoft Office, including Word, Outlook, and Excel.


• Basic knowledge of medical billing practices and insurance payment processes.


• Familiarity with EHR and practice management systems preferred.


• Basic familiarity with CMS-1500 claim form completion preferred.


• Ability to pass criminal background check, OIG exclusion screening, and drug screening.


• Reliable transportation.

• Strong attention to detail and accuracy.


• Ability to perform repetitive tasks with consistency.


• Basic written and verbal communication skills.


• Ability to accept direction and work cooperatively with team members.


• Basic understanding of healthcare billing procedures, documentation, and payment cycles.


• Ability to organize work, manage routine tasks, and maintain records.


• Basic computer and data entry skills.


• Ability to identify routine payment or account issues and escalate more complex matters appropriately.


• Ability to maintain confidentiality and follow HIPAA requirements.

• None.

Representative duties are listed below. Percentage estimates are approximate and may vary based on business need.a Approx. % Key Duties

Claim and Payment Processing 70%

• Review EOBs, remittance advice, electronic deposits, and paper checks for routine posting activity. 70%


• Post payments accurately to patient accounts based on established procedures.


• Annotate accounts with basic payment and insurance information,


• Perform routine account maintenance and identify obvious payment posting errors for correction or escalation.


• Maintain organized supporting documentation for posted transactions.


• Assist with straightforward insurance follow-up tasks as assigned.

Communication 10%

• Communicate with insurance companies, patients, or guarantors regarding basic claim or payment questions, as directed.

• Route more complex denials, appeals, or account issues to senior staff or supervisor.

Documentation and File Maintenance 10%

• Maintain and organize master document files for verification and backup of entered data.


• Ensure supporting billing documentation is present and properly filed.

Stay Updated 5%

• Review payer bulletins, office guidance, and procedural updates relevant to assigned tasks.

Compliance and Safety 5%

• Follow safety policies and department procedures.


• Maintain confidentiality and comply with HIPAA and billing requirements.


• Participate in required training.

• Frequently lift or move up to 10 pounds using provided tools.


• Requires ability to read, enter, and review information accurately.


• Frequent repetitive hand motion due to data entry.


• Regularly required to talk and hear, and occasionally stand, sit, stoop, kneel, or crouch.


• Requires manual dexterity and eye-hand coordination.


• Frequent phone use may be required.

• Work schedule is generally Monday through Friday, 8:00 a.m. to 5:00 p.m., with slight modifications possible based on business need and manager approval.


• Work is normally performed in an office environment with moderate noise.


• Must be able to work additional hours as needed to support department operations.

This position is designated as an on-site, patient-facing role. In-office presence is an essential function due to the need for real-time collaboration with providers, direct interaction with patients and caregivers, and secure handling of health data in compliance with HIPAA.

To request a reasonable accommodation for any part of the application or hiring process, please see our Accessibility Statement or contact Human Resources at

hr@easternnephrology.com or 252-864-2049.