Insurance Specialist

Job: Insurance Specialist II/Sr

Hours: Monday - Friday, 8:00 - 4:30 p.m.

Pay Range: $22.87 - $28.60 an hour. The actual hiring rate may vary based on several factors, including your previous work experience, educational background, the responsibilities of the position, and demonstrated performance. These elements help us ensure a fair and competitive offer aligned with your qualifications and the role's requirements.

Benefits: We offer a competitive benefits package that includes medical, dental, vision, life insurance, short-term and long-term disability coverage, generous PTO, an employer match 401K plan, a wellness program, tuition reimbursement, an employee assistance program (EAP), and retail discounts.

Job Summary: Shenandoah Oncology is seeking a detail-oriented and proactive Insurance Specialist II/Sr to support our mission of delivering exceptional patient care. In this role, you'll ensure timely resolution of payer and patient account balances, perform collection activities, and address billing inquiries with professionalism and empathy. You'll work under general supervision, following established procedures to monitor delinquent accounts, contact patients regarding payments, and resolve billing issues.

• Monitors delinquent accounts and performs collection duties.
• Reviews reports, identifies denied claims, researches and resolves issues, may perform a detailed reconciliation of accounts, and resubmits claim to payer.
• Reviews payment postings for accuracy and to ensure account balances are current.
• Works with co-workers to resolve payment and billing errors.
• Monitors and updates delinquent accounts status.
• Recommends accounts for collection or write-off.
• Verifies existing patients have necessary referral and/or authorization documentation prior to examination date.
• Contacts and follows up with patient's physician for any missing or incomplete documentation.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• May refer patients to Patient Benefits Representative to set up payment plans.
• Contacts third party payors to resolve payor issues, expedite claim processing, and maximize medical claim reimbursement.
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations.
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records.
• Performs other duties as requested or assigned.

• High School diploma or equivalent required.
• Minimum four (4) years combined medical billing and payment experience required.
• Demonstrate knowledge of medical coding, preferably oncology coding.
• Demonstrate knowledge of state, federal, and third party claims processing required.
• Demonstrate knowledge of state & federal collections guidelines.
• Must successfully complete required e-learning courses within 90 days of occupying position.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The position requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. The position requires standing and walking for extensive periods of time. The employee occasionally lifts and carries items weighing up to 40 lbs. The position requires corrected vision and hearing to normal range.

Work Environment: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.