Insurance Claim Specialist

Southern Ohio Medical Center; Portsmouth (OH); On-site; USD 25,000 - 36,000; Full time

Benefits offered by this job

Competitive pay

Retirement plan

Medical coverage

Tuition assistance

Earned Wage Access

Job summary

Southern Ohio Medical Center is seeking an Insurance Claim Specialist who will analyze, process, submit, and follow up on inpatient and outpatient medical claims under the supervision of the Assistant Manager of Claims Management. This role protects patient confidentiality and ensures accurate claim handling across commercial and government programs.

Qualifications include a High School Diploma and 3–6 months of related medical billing experience.

Qualifications

• Education: High School Diploma or equivalent required.

Responsibilities

• Reviews all claims for complete and accurate information.
• Contacts SOMC departments, physician offices, and insurance companies to obtain necessary information to file complete, accurate, and timely claims.
• Processes, edits, and submits all claims for the organization.
• Follows up on Commercial, Worker’s Comp, VA, and Governmental claims by phone, website, or online resources.
• Works with patients/guarantors by phone to assist with questions on unpaid claims.

Skills

Medical billing

Claims processing

HIPAA compliance

Customer communication

Education

High School Diploma

Job description

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process.

GENERAL SUMMARY

Works under the supervision of the Assistant Manager of Claims Management and Lead Insurance Claim Specialists. The Insurance Claim Specialist's primary job functions is to analyze, process, submit, and follow up on inpatient and outpatient medical claims. Is responsible for safeguarding the public relations and confidentiality of the organization and its records by consistent professional conduct.

QUALIFICATIONS

Education:

• High School Diploma or successful completion of an equivalent High School Exam Required

Licensure:

• None

Experience:

• Three to six months of related work experience in medical billing preferred

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS

The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Reviews all claims for complete and accurate information.
• Contacts other SOMC departments, physician offices, and insurance companies to obtain necessary information to file complete, accurate, and timely claims.
• Processes, edits, and submits all claims for the organization.
• Follows up on Commercial, Worker's Comp, VA, and Governmental claims by phone calls to the insurance companies, websites, or any online resources available.
• Works with the patient/guarantor by phone to assist with any questions regarding unpaid claims. Obtains information from the patient/guarantor with which to submit the claim for payment (i.e., claim forms, Medicare Secondary Payer (MSP) Questionnaire, etc.)
• Processes administrative appeals, reinstatements, and rejections of insurance claims.
• Completes account follow up daily, maintaining established goals, and notifies the Lead Specialist, when necessary, of issues preventing achievement of such goals.
• Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues.
• Adheres to HIPPA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
• Identifies billing and coding issues with individual claims, notifying medical billers for correction.
• Makes determinations through on-line systems of patient eligibility, coverage, and reviews status of claims.
• Performs other duties as assigned.

Why SOMC? You Care for Our Patients, We Care for You

At Southern Ohio Medical Center, our mission is to make a difference in the community we serve. We're committed to delivering exceptional care and that starts with our team members. When you join SOMC, you're not just starting a job. You're joining a mission.

• Competitive pay with quarterly market analysis
• Performance-based annual increase and bonus eligibility
• Up to 4% employer contributions to retirement plans (403(b) and Cash Balance Pension)
• Comprehensive medical, dental, and vision coverage*
• Medical and dependent care flexible spending accounts*
• Earned Wage Access - get paid before payday
• Paid Time Off bank with 3 annual sick days
• Life insurance and disability coverage*
• Tuition and certification assistance
• Club LC - discounted/free gym membership
• Employee discount and payroll deduct programs
• And many other benefit offerings!

*Available only to Full-Time and/or Part-Time Employees

Compensation & benefit eligibility is determined by employment status, position type, and hours worked. Offerings are subject to change and governed by SOMC's current plan documents and policies. Specific details will be reviewed upon hire as part of the onboarding process.

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position in accordance with applicable law. A full job description is available upon request.

Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.