Insurance Analyst

Heritage Medical Associates, P.C.; Nashville (TN); On-site; USD 42,000 - 62,000; Full time

Job summary

Heritage Medical Associates, P.C. in Nashville, TN is seeking an Insurance Analyst to manage denied and pending insurance claims, submit appeals, and maintain billing queues.

The role emphasizes excellent customer service to patients and staff, with responsibility for answering questions about insurance benefits and balances. The position requires 3–5 years of third‑party physician billing, ICD-10/CPT coding knowledge, and experience with medical billing systems, ensuring compliance and accuracy

Qualifications

• High school diploma required; 3–5 years of third-party billing in a physician's office.
• Knowledge of ICD-10/CPT coding.
• Experience in medical billing systems.
• Thorough understanding of Medicare/Medicaid laws, managed care, and commercial health insurance.
• Strong customer service and communication skills.
• Excellent telephone etiquette.

Responsibilities

• Work denied claims through the practice management queue.
• Process denials in a timely and accurate manner.
• Create and submission of appeals.
• Communicate with insurance companies as needed.
• Query provider in a timely manner as needed.
• Interpret and apply compliance guidelines to maintain billing integrity.
• Audit accounts referred by Patient Service Representatives and Patient Accounts.
• Post corrected claims and any payments associated with that correction.
• Transfer credits in an account.
• Apply self-pay discounts, charity and per request adjustments.
• Verify balances and refunds for accuracy; ensure timely follow up with patient.
• Follow HMA guidelines in applying self-pay discounts and adjustments.

Skills

Strong Customer Service

Telephone etiquette

Written and verbal communication

Supervision independence

Organizational skills

Self motivated

Team collaboration

Attendance

Education

High school diploma

Job description

SUMMARY: Insurance Analysts demonstrate thorough knowledge of the claims revenue cycle. The Insurance Analyst position is responsible for answering patient and staff inquiries, reviewing outstanding and/or denied insurance claims, submitting insurance appeals, and maintaining assigned insurance queues.Insurance Analyst must have the ability to provide excellent Customer Service to patients and staff and correctly answer a question regarding insurance and balances. The type of questions may include, but are not limited to insurance participation, correct coding guidelines, carrier specific medical policies, and denial codes, review of accounts for payment application, as well as the ability to assist patient and/or staff in understanding insurance benefits and how the benefits were applied to the service(s) received at HMA.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties maybe assigned.)Work denied claims through the practice management queueProcessing of denials in a timely and accurate mannerCorrect and any denied claim, including submitting additional information or documentation as requestedCreation and submission of appealsCommunicate with insurance companies, as neededQuery provider in a timely manner, as neededInterpret and apply compliance guidelines to maintain billing integrityUpdate and maintain patient account information and have the ability to make adjustments as necessary, and according to company policyReceive, sort and work incoming correspondence dailyIdentify and communicate trends in denials to managementAnswer patient questions, inquiries and concerns regarding their accounts; verify balances and refunds for accuracy, and ensure timely follow up with patient, as needed.Audit accounts referred by Patient Service Representatives and Patient Accounts, as well as provide a response in a timely mannerUtilize the Insurance Analyst work queues to follow up on accounts until the account has been satisfactorily resolved.Post corrected claims and any payments associated with that correctionTransfer credits in an accountFollow HMA guidelines in applying self-pay discounts, charity and per request adjustments.SUPERVISORY RESPONSIBILITIES:NoneQUALIFICATIONS:Strong Customer Service SkillsExcellent telephone etiquette and skillsExceptional written and verbal communication skillsAbility to work with little supervisionSuperior organizational skillsSelf motivatedAbility to work in a cooperative manner with othersRegular and predictable attendanceEDUCATION and/or EXPERIENCE:High school diploma3-5 years of third-party billing in a physicians officeKnowledge of ICD-10/CPT CodingExperience in medical billing systemsMust have thorough understanding of Medicare/Medicaid laws, managed care, and commercial health insurancePHYSICAL DEMANDS:Must be able to walk to patient in physicians office and/or sit for 8 to 10 hours a dayRequires regular walking, bending, pushing, pulling, twisting and liftingMust be able to lift at least 10-15lbsAbility to delineate between numeric numbersWORK ENVIRONMENT:Office environment-limited exposure to communicable diseases.No exposure to blood-borne pathogens or contaminated body fluidsFast paced environment