Insurance Reimbursement Specialist
SIGNATURECARE EMERGENCY CENTER MASTER
Summary
The Insurance Reimbursement Specialist is responsible for the collection, follow-up, and appeals of insurance claims. Essential to this position is the ability to manage all insurance follow-up for maximum insurance reimbursement, including outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials, and resolving unpaid claims.
Job description
Job Responsibilities/Duties
- Work assigned claims accurately, efficiently, and within established departmental and corporate timeframes.
- Understand and stay informed of changes to procedures, billing guidelines, and laws for specific insurance carriers or payers.
- Research claim status, payment discrepancies, denials, coding or billing issues, authorization concerns, eligibility problems, and payer-specific requirements.
- Actively follow up and collect on all claims, including resolution of any billing errors following established procedures.
- Follow all departmental policies, standard operating procedures, compliance requirements, and leadership directives.
- Protect patient information and comply with HIPAA and all organizational confidentiality requirements.
- Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.
- Perform other duties as assigned by department manager.
Working Conditions
- Frequent speaking, listening, using a headset, use of hands/fingers across keyboard or mouse, handling other objects, and long periods working at a computer.
- Service center with moderate noise level due to representatives talking, computers, printers, and floor activity.
- While performing duties of this job, the employee is frequently required to stand, walk, and sit.
- Must submit to random drug screenings.
Requirements
- High school diploma or GED required
- Minimum of three years of experience in medical insurance follow-up, collections, denial management, and reimbursement
- Knowledge of both in-network and out-of-network facility and professional claims
- Strong knowledge of claim status follow-up, denial resolution, corrected claims, reconsiderations, and appeals
- Ability to read, analyze, and interpret EOBs, ERAs, payer correspondence, denial codes, and reimbursement information
- Proven experience preparing and submitting appeals in a high-volume claims environment
- Experience working in a production-based environment and consistently meeting productivity, accuracy, and quality expectations
- Strong verbal and written communication skills
- Ability to clearly communicate claim issues, reimbursement discrepancies, and appeal requests to insurance representatives
- Excellent analytical, problem-solving, research, and negotiation skills
- Ability to prioritize assignments, manage multiple deadlines, and work independently with minimal supervision
- Positive attitude and demonstrated ability to collaborate effectively with team members and leadership
- Proficiency with Microsoft Windows, Excel, Word, payer portals, and other medical billing applications
- Ability and willingness to learn new software, payer systems, and reimbursement processes
- Experience working with commercial insurance carriers, including UHC, Cigna, Aetna, BCBS, Marketplace plans, workers' compensation, and third-party liability claims is preferred
- Knowledge of EPOWERDOC and Centricity is preferred
- Typing speed of 45-60 words per minute preferred
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- HSA & FSA options
- Company-paid life insurance
- Long-term disability
- 401(k) matching
- 401(k) vesting after 3 years
- Paid Time Off
- Paid Holidays
- Employee discounts
Company overview
SignatureCare Emergency Center Master is a healthcare organization specializing in freestanding emergency medical services. Operating as a network of emergency care facilities, the company provides urgent medical treatment for non-life-threatening conditions that require immediate attention but don't warrant a traditional hospital emergency room visit. These centers typically offer extended hours, shorter wait times, and more convenient access compared to hospital-based emergency departments. SignatureCare facilities are staffed by board-certified emergency physicians and trained medical professionals equipped to handle a wide range of acute medical conditions including fractures, lacerations, infections, respiratory issues, and minor trauma. The company focuses on delivering high-quality emergency care with patient-centered approaches, often featuring advanced diagnostic capabilities such as on-site laboratory testing, digital X-ray, CT scanning, and ultrasound services. As part of the growing trend in healthcare accessibility, SignatureCare Emergency Center Master represents a modern approach to emergency medicine that bridges the gap between primary care clinics and hospital emergency rooms.