Insurance Collections Specialist

Hialeah-Hospital; Florida; On-site; USD 60,000 - 80,000; Full time

Job summary

Hialeah Hospital is seeking a patient account follow-up specialist to maintain accurate accounts receivable. Under supervision, you will handle insurance follow-up, credit balances, and denial resolutions, ensuring timely and accurate payments.

You will resubmit claims, file reconsideration letters, and verify eligibility while supporting audits and refunds as needed. Strong knowledge of payer contracts and managed care is essential.

Qualifications

• High School graduate or equivalent required.
• Minimum 1 year billing/insurance follow-up experience.
• Knowledge of HMO, PPO, Commercial, and Workers' Compensation reimbursement.
• Working knowledge of Managed Care contract language and interpretation.

Responsibilities

• Follow up with insurance carriers to resolve outstanding balances.
• Resubmit claims with appropriate remarks and attachments when needed.
• File insurance reconsideration letters for payment/denial disputes.
• Validate accounts for accurate payments, discounts and contractual adjustments.
• Respond to insurance carrier correspondence as appropriate.
• Run insurance eligibility checks and ensure correct claims before resubmission.
• Pull supporting documents for annual regulatory audits as needed.
• Ensure credit balance and refund requests are resolved timely.
• Answer incoming calls resolving patient and/or insurance issues promptly.
• Assist with other duties as assigned within your skill set.

Skills

Insurance follow-up experience

Education

High School diploma or equivalent

Job description

Hialeah Hospital is seeking a patient account follow-up specialist to maintain accurate accounts receivable. Under supervision, you will handle insurance follow-up, credit balances, and denial resolutions, ensuring timely and accurate payments.

You will resubmit claims, file reconsideration letters, and verify eligibility while supporting audits and refunds as needed. Strong knowledge of payer contracts and managed care is essential.