Insurance Claims & Denials Specialist

Northeast Georgia Medical Center; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Northeast Georgia Health System (NGHS) seeks an Insurance Specialist to serve as the primary contact for patient questions related to insurance claims, denials, coding, re-determinations, settlements, and retro authorizations.

The role handles credit balances and pay discrepancies, reviews prior billing activity, and acts as a subject matter expert on payer guidelines to improve underpayment recovery and claim adjudication.

Qualifications

• CPAR and CPB or CPC certification; CPB or CPC can be obtained within one year of hire.
• High School Diploma or GED.
• Minimum 3 years of medical billing and/or medical coding experience.

Responsibilities

• Verifies and updates patient insurance coverage and rebills claims as appropriate.
• Resolves patient inquiries by phone and electronic messages; deescalates complaints.
• Researches and resolves billing issues with payers and patients; reviews EOBs for accuracy.
• Maintains understanding of HIPAA regulations and patient privacy.
• Supports department to meet quality and productivity standards.
• Liaises with patients and payers to resolve insurance billing issues.

Skills

Customer service

Communication

Computer skills

HIPAA knowledge

Independent work

Interpersonal skills

Education

High School Diploma or GED

Job description

Northeast Georgia Health System (NGHS) seeks an Insurance Specialist to serve as the primary contact for patient questions related to insurance claims, denials, coding, re-determinations, settlements, and retro authorizations.

The role handles credit balances and pay discrepancies, reviews prior billing activity, and acts as a subject matter expert on payer guidelines to improve underpayment recovery and claim adjudication.