Insurance Claims Specialist

Position Summary: The Insurance Claims Specialist reflects the mission, vision, and values of the organization, adheres to the organization’s Code of Ethics and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Insurance Claims Specialist under the direction of the Revenues Cycle Lead will be generally responsible for insurance claims submissions and resubmissions (appeal) based on the agreed contract with each payer in the region. Key Role Responsibilities: The position holder will be responsible for the below: SUBMISSIONS: • Reviews accuracy and completeness of information requested and ensure that all supporting documents are present • Receives requests for pre-authorizations and ensure that they are properly and closely monitored • Consults with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity • Processes referrals and submit medical records to insurance carriers to expedite prior authorization processes • Manages correspondence with insurance companies, physicians, specialists and patients as required • Looks through denials and submit appeals in a bid to get them approved from insurance companies • Creates