Insurance Specialist - (A/R & Appeals)

Overview

Job: Insurance Specialist - Revenue Cycle (A/R & Appeals)

Hours: Monday - Friday, 8:00 – 4:30 p.m. or 8:30 - 5:00 p.m. (100% on-site)

Pay Range: $22.87 -$28.60 an hour. The actual hiring rate may vary based on several factors, including your previous work experience, educational background, the responsibilities of the position, and demonstrated performance. These elements help us ensure a fair and competitive offer aligned with your qualifications and the role's requirements.

Benefits: We offer a competitive benefits package that includes medical, dental, vision, life insurance, short-term and long-term disability coverage, generous PTO, an employer match 401K plan, a wellness program, tuition reimbursement, an employee assistance program (EAP), and retail discounts.

Job Summary: Shenandoah Oncology is looking for a Healthcare Insurance Specialist that will embody our core values, The RETIC Way: Respect, Excellence, Teamwork, Integrity, and Compassion. The Medical Insurance Specialist manages medical billing and insurance accounts by resolving claim discrepancies, working insurance accounts receivable (A/R), preparing and submitting payer appeals for denied claims, and securing outstanding balances. This role ensures accurate payment posting, refunds, and account resolution while serving as a patient‑facing resource for billing and insurance inquiries. All responsibilities are performed in strict compliance with HIPAA and applicable regulatory requirements.

Responsibilities

• Monitors delinquent accounts and performs collection duties
• Reviews reports, researches and resolves issues
• Reviews payment postings for accuracy and to ensure account balances are current
• Works with co-workers to resolve insurance payment and billing errors
• Monitors and updates delinquent accounts status
• Recommends accounts for collection or write-off
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations
• Answers patient payment, billing, and insurance questions and resolves complaints
• May refer patients to Patient Benefits Representative to set up payment plans
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records
• Performs other duties as requested or assigned
  
  

Qualifications

• High School diploma or equivalent required
• Minimum two (2) years combined medical revenue cycle (billing, A/R, and denial) experience.
• Demonstrate knowledge of state, federal, and third party claims processing required
• Demonstrate knowledge of state & federal collections guidelines
• Must successfully complete required e-learning courses within 90 days of occupying position
  
  

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to manipulate a computer keyboard and mouse. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation will be offered to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent contact with staff. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to blood, toxic substances, ionizing radiation and other conditions common to a clinic environment.