Insurance Specialist

The Orthopaedic & Fracture Clinic, P.A.; Mankato (MN); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health, dental, vision insurance

Paid time off

Job summary

The Orthopaedic & Fracture Clinic, P.A. is hiring an Insurance Specialist to verify patient benefits, manage referrals, process claims and appeals. You will communicate with patients and staff about coverage, copays, and authorizations.

Responsibilities include collecting payments, resolving billing questions, and updating records within the EHR while staying current on payer policies. A high school diploma and experience in healthcare are required.

Qualifications

• High school diploma or equivalent, or 2+ years in healthcare setting.
• Experience in insurance processing, claims, or billing.
• Proficiency with Microsoft Word, Excel and Outlook.

Responsibilities

• Verify patient benefits, manage referrals, process claims and appeals.
• Collect and process patient payments and assist with billing questions.
• Explain benefits and discuss out-of-pocket costs with patients.
• Resolve insurance issues with registration, scheduling and providers.
• Update records and stay current with payer policies.
• Complete required compliance and safety training.

Skills

Insurance processing

Claims processing

Billing

Microsoft Office

Education

High School Diploma

Tools

Availity

Job description

Position Purpose:

The Insurance Specialist verifies patient benefits, manages referrals, processes claims, appeals denials, and communicates with patients and staff about coverage, copays, deductibles, and authorization statuses, ensuring smooth financial and administrative flow for orthopedic treatments. They act as a liaison between patients, providers, and insurance companies, maintaining up-to-date records and keeping current on payer policies.

Essential Responsibilities (Non-Occupational Exposure):

• Work on various insurance accounts including importing charges, processing payments, filing appeals, and any necessary follow-up on any unpaid or denied claims, file appeals and resolve billing issues.
• Collect and process patient payments and assist patients with billing questions.
• Handles private pay, claims on loans, returned checks, refunds and adjustments on employee accounts.
• Complete employment-related leave of absence and disability paperwork.
• Explain benefits, discuss out-of-pocket costs and answer patient questions.
• Work with registration, scheduling, therapists, and providers to resolve insurance issues and update records.
• Update patient information in the EHR, research payer policies, and maintain knowledge of changing insurance requirements.
• Ensure business office tasks, phone calls and walk-ins are covered.
• Cross train in all aspects of the Business Office.
• Completion of all required compliance and safety training.
• Special projects and other duties as assigned.

Competencies:

• Excellent public relations skills.
• Ability to thrive in a fast-paced and high volume workload.
• Strong organizational and time management skills with high attention to detail and the ability to multitask.

• Excellent communication skills, ability to work closely with providers.

• Demonstration of good time management skills, maintain a positive teamwork environment, and be detail oriented.
• Willingness to learn Electronic Health Records and other pertinent software.
• Ability to troubleshoot issues through to resolution.

Qualifications

Basic Requirements:

• High school diploma or equivalent, or a minimum of two years of experience in a healthcare, clinical, or hospital setting.
• Experience in insurance processing, claims, or billing.
• Proficiency in Microsoft Office Word, Excel, and Outlook.

Preferred Requirements:

• Strong knowledge of medical insurance (HMO, PPO, auto, etc.).
• Previous experience in healthcare setting and knowledge of medical terminology, medical insurance filing and insurance appeals.
• Experience with insurance authorizations and eligibility.
• Knowledgeable in programs such as Availity and insurance websites.

Benefits:

Full-time employees are eligible for comprehensive benefits, including health, dental, vision, disability, and life insurance. They earn Paid Time Off, Extended Illness Time, and Holiday Pay. They are allowed to participate in our 401(k)/profit-sharing plan.

Additionally, OFC believes in creating a fun work environment. We host an annual holiday party, a summer employee event, volunteer opportunities, a Super Bowl auction, various potlucks, and ice cream treats before Memorial and Labor Day weekends.

Disclaimers:

This job description is not intended to be a comprehensive listing of all activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time, with or without notice. This notification confirms the Orthopaedic & Fracture Clinic's commitment to providing equal employment opportunities to all employees and job applicants, in accordance with all applicable federal, state, and local laws, directives, and regulations. The Orthopaedic & Fracture Clinic will consider all applicants for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, or disability status. Upon request, the Orthopaedic & Fracture Clinic will provide entities with a copy of our current Equal Employment Opportunity policy. If you want to receive a copy of our policy or would like to request as reasonable accommodation for applying to this position, please email [e-mail] or call 507-396-6689.