Insurance Specialist

Core Responsibilities:

* Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.

* Independently write professional appeal letters.

* Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as WCR policies and procedures.

* Submit retro-authorizations in accordance with payor requirements in response to authorization denials.

* Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.

* Make recommendations for additions/revisions/deletions to claim edits to improve efficiency and reduce denials.

* Identify opportunities for process improvement and actively participate in process improvement initiatives.

Customer Service Standards:

* Support co-workers and engage in positive interactions.

* Communicate professionally and timely with internal and external customers.

* Ability to stay calm under pressure and deal effectively with insurance company associates