Specialist, Insurance Revenue Cycle

SHERLOQ Solutions; Tampa (FL); On-site; USD 25,000 - 30,000; Full time

Benefits offered by this job

Medical insurance

401(k)

Paid time off

Paid holidays

Tuition reimbursement

Supplemental benefits

Job summary

SHERLOQ Solutions in Tampa, FL is seeking a Claims Billing Specialist to act as the communication bridge between healthcare providers and health insurer payers, to expedite claim resolution and maximize reimbursement. You will verify patient and insurance information, navigate provider systems and payer portals, review explanations of benefits, and analyze denials.

The role requires attention to detail, strong written and verbal communication, and the ability to work under pressure in a busy

Qualifications

• High school diploma or equivalent.
• 3 years of healthcare industry experience.
• 1 year in healthcare claims billing, insurance collections, coding, or denials management.
• Acquire HFMA CRCR or AAHAM CRCS within 2 years.

Responsibilities

• Resolve healthcare claims through verbal or online inquiries to payers.
• Navigate provider systems, billing platforms, and payer websites.
• Verify patient, insurance, billing and submission information for accuracy.
• Conduct eligibility inquiries and COB research.
• Analyze payer denials and respond to secure reimbursement.
• Inform Billing & Appeals Specialists on appeals when needed.
• Track payer underpayments, coding issues and denials; report trends.
• Identify basic coding denials and initiate corrections or disputes.
• Check insurance payments for accuracy and contract compliance.
• Research missing payments and obtain documents for posting.
• Maintain professionalism in high-volume environments and meet targets.

Skills

Communication

Interpersonal skills

Attention to detail

Reading EOB

Problem solving

MS 365

Education

High School Diploma

HFMA CRCR / AAHAM CRCS accreditation

Tools

Microsoft 365 (Teams, Outlook, OneDrive, SharePoint)

Job description

About SHERLOQ Solutions

Established in 1916, SHERLOQ began as a member-owned cooperative in Tampa, Florida. The founding mission was to facilitate the sharing of credit information, promote the equitable principles in trade and give back to the community. Over 100 years later, SHERLOQ continues as a vibrant company serving hospitals, healthcare systems, physician practices and utilities nationwide.

Position Summary

This position will require the employee to effectively communicate between healthcare providers and health insurance payers to expedite claim resolution.

Essential Duties And Responsibilities

• Resolve healthcare claims through verbal or online inquiries to health insurance payers.
• Effectively navigate and utilize healthcare provider systems, billing platforms, and payer websites.
• Verify patient, insurance, billing and claim submission information for accuracy.
• Eligibility inquiries and coordination of benefits research including reaching out to the patient when necessary.
• Analyze payer denials and appropriately respond to secure claim reimbursement.
• Provide information to the Billing & Appeals Specialists on claims that require written appeals.
• Track trends in payer underpayments, coding issues and denials and report to leadership for escalation.
• Recognize basic coding denials and request appropriate action for correction or dispute.
• Check insurance payments for accuracy and compliance with contract discount.
• Research missing payments and secure documents needed for posting.
• Demonstrated ability to remain patient, professional & effective in high pressure and high-volume environments.
• Meet or exceed daily, weekly and monthly performance goals, deadlines and objectives.
• Perform other related duties as assigned.

Abilities

• Excellent verbal and written communication skills.
• Excellent interpersonal and negotiation skills.
• Organized with attention to detail.
• Ability to read and interpret insurance explanation of benefits.
• Ability to problem solve and think critically to identify trends.
• Demonstrated proficiency in Microsoft 365 (Teams, Outlook, OneDrive, SharePoint) within a cloud-based, collaborative environment.

Experience And Education

• High school graduate or equivalent required.
• Three (3) years of healthcare industry experience required.
• One (1) year of healthcare claims billing, insurance collections, coding, and/or denials management required.
• Specific healthcare payer experience may be required (e.g., Medicare or state-specific payers).
• Obtain HFMA CRCR or AAHAM CRCS accreditation within two years of employment and maintain certification in good standing.

Pay Range: $18+ per hour

Schedule: Monday- Friday 8am-5pm

Benefits

• medical insurance
• 401(k)
• paid time off
• paid holidays
• tuition reimbursement
• additional supplemental benefits

SHERLOQ is an Equal Opportunity Employer and considers all qualified applicants without regard to race, color, religion, sex, national origin, disability, or veteran status.

Salary: $18 per hour