Insurance Denial and Billing Specialist

Job Description:

We are seeking a detail-oriented and experienced Insurance Denial and Billing Specialist to join our team. In this dual-role position, you will be responsible for both managing and appealing denied insurance claims and overseeing the billing process to ensure timely and accurate payments. You will play a critical role in resolving discrepancies, reviewing claim denials, and facilitating seamless billing and payment operations for our organization or clients.This position requires a strong understanding of insurance policies, billing processes, and the ability to communicate effectively with insurance providers and healthcare professionals.

Key Responsibilities:
Insurance Denial Management:

• Review and analyze denied insurance claims to determine the cause of the denial.
• Work with insurance providers, healthcare professionals, or clients to gather additional information or clarify issues.
• Appeal denied claims with proper documentation and supporting evidence to ensure successful resolution.
• Maintain accurate records of all denied claims, communications, and resolutions.
• Track and follow up on claims to ensure timely resolution and payment.

Billing and Payment:

• Prepare and submit accurate insurance claims to various insurance providers.
• Verify the accuracy of billing codes, insurance information, and claim details before submission.
• Resolve any billing discrepancies by working closely with clients, insurance providers, or internal departments.
• Assist with financial reporting related to insurance billing and claims.

Cross-functional Collaboration:

• Collaborate with billing, coding, and customer service teams to ensure efficient and accurate billing and claims processing.
• Provide guidance and support to team members regarding billing and insurance denial procedures.

Other Responsibilities:

• Stay current on insurance policies, billing regulations, and industry trends.
• Participate in ongoing training and professional development programs.
• Meet daily/weekly/monthly targets for both claim resolution and billing submissions.

Qualifications:

• High school diploma or equivalent (required); Associate’s or Bachelor’s degree in Business Administration, Healthcare Administration, or a related field (preferred).
• 2 years of experience in insurance claims, billing, or denials management (medical or general insurance experience preferred).
• Strong understanding of insurance billing procedures, codes (CPT, ICD, etc.), and insurance policies.
• Experience with claims software or billing systems (Epic, Waystar and ADS).
• Strong attention to detail and the ability to manage multiple priorities efficiently.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office Suite (Excel, Word, etc.).
• Ability to work independently and as part of a collaborative team.
• Strong problem-solving and analytical skills.

Pay: $18.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Education:

• Associate (Preferred)

Experience:

• insurance claims, billing, or denials management: 2 years (Preferred)

Ability to Commute:

• Green Bay, WI 54303 (Required)

Work Location: In person

Salary : $18 - $25