Insurance Specialist 3

Job Summary

Resolving complex unpaid claims, the full-time remote Insurance Specialist 3 will prepare and submit claims to Medicare, Medicaid, and private insurers while ensuring compliance with billing regulations and coordinating with clinical and finance teams within the Hawaii Time Zone.

Key responsibilities

• Resolve higher-dollar unpaid/denied claims for long-term care and skilled nursing facility claims
• Prepare and submit claims, ensuring compliance with federal and state billing regulations while verifying coverage and eligibility
• Coordinate with various teams to maintain accurate documentation and optimize reimbursement through proper coding and timely claims submission

Required qualifications

• High School Diploma or equivalent
• 5+ years of relevant industry experience in registration, billing, and collections
• 3+ years of experience with LTC and/or SNF claims resolution
• Knowledge of UB04 claim forms, EOBs, and medical records
• ICD-9, ICD-10, CPT, and HCPCS coding knowledge