Insurance Specialist 3 (Remote, Hawaii Time Zone)
About Us:Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY:ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.This is a REMOTE within US Only (Hawaii Time Zone)About this position:Location: Remote within US Only - must work in Hawaii Time Zone).Required Schedule: Monday - Friday 7:30 AM - 4:00 PM (HI - Hawaii Time Zone)Duties include but not limited to:Resolving complex, higher-dollar unpaid/denied claims for long-term care (LTC), skilled nursing facility (SNF) or intermediate care facility (ICF) claims.Preparing and submitting claims to Medicare, Medicaid, and private insurers; ensuring compliance with federal and state billing regulations (including UB-04 and RAI/MDS requirements); verifying coverage and eligibility; and resolving claim denials or discrepancies.Coordinating with clinical, admissions, and finance teams to ensure accurate documentation, maintaining patient billing records, and optimizing reimbursement through proper coding and timely claim submission.Possessing knowledge of LTC billing systems, reimbursement models, and payer guidelines is essential.Identifying and reporting trends found during the account resolution process such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, no claim on file.Performing financial account assessment functions including but not limited to adjustments and determining balance to patient.Working within client systems to complete rebill functions.Performing administrative functions including but not limited to medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests and approve for client assistance or correct the bill within client platform, review and submit payment verification assistance requests.Maintain familiarity with client preferences and known issues across multiple client accounts.Support special projects for clients as needed.Other duties as assigned.QUALIFICATIONS:High School Diploma or equivalent5+ years relevant indus...