Insurance Specialist

Quadax, Inc.; Middleburg Heights (OH); On-site; USD 36,000 - 52,000; Full time

Job summary

Quadax, Inc. is seeking an experienced Healthcare Billing Specialist to follow up on claim status, resolve rejections, and verify coverage. The role involves communicating with payers and patients to ensure accurate adjudication.

Candidates should have a high school diploma or GED, knowledge of medical terminology, and strong problem-solving and communication skills. Proficiency in Word and Excel and the ability to maintain confidentiality are essential.

Qualifications

• High School diploma or GED is required.
• Previous health insurance billing experience.
• Working knowledge of medical terminology.
• Strong problem-solving skills and ability to adapt to policy changes.
• Excellent written and verbal communication skills.
• High attention to detail.
• Ability to interact effectively with others.
• Ability to maintain confidentiality.
• Proficient computer skills with Word and Excel.

Responsibilities

• Follow up on claim status via portals or calls to determine adjudication.
• Call payers and patients to resolve claim rejections and verify coverage.
• Verify patient insurance eligibility and coordination of benefits.
• Review and analyze payer correspondence.
• Investigate electronic claim rejections.
• Submit claims for processing corrections or to updated addresses.
• Research requests for insurance payment retractions.
• Monitor payer trends and notify management of issues.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Skills

Medical terminology

Attention to detail

Communication skills

Problem-solving

Education

High School diploma or GED

Tools

Microsoft Word

Excel

Job description

• Follow up on claim status via insurance portals or calls to payers to determine adjudication and details.
• Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage.
• Verify patient insurance eligibility and coordination of benefits.
• Review and analyze payer correspondence.
• Investigate electronic claim rejections.
• Submit claims for processing corrections, to secondary insurances, or to updated addresses.
• Research requests for insurance payment retractions.
• Monitor and notify management of payer trends and/or claim processing issues.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Education/Experience:

• High School diploma or GED
• Previous health insurance billing experience
• Working knowledge of medical terminology
• Strong problem-solving skills and the ability to adapt to changes in policies, regulations, and procedures
• Excellent written and verbal communication skills
• High attention to detail
• Ability to interact effectively with others
• Ability to maintain confidentiality
• Proficient computer skills with knowledge of Microsoft Word and Excel

Equal Opportunity Employer
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