Manages and evaluates insurance claims to ensure accurate coverage and timely processing. Investigates claims, negotiates settlements, and responds to inquiries from claimants and related parties. Assists clients in submitting claims correctly and coordinates with internal teams to facilitate efficient claim resolution. Maintains detailed records and verifies claim compliance are key to supporting audit and regulatory requirements.
Responsibilities:
The Insurance Claims Support Specialist is responsible for a wide range of administrative and operational tasks, including but not limited to:
Review medical record request via Availity and route to UF ROI department.
Medical record follow - up with payer to ensure records are received and in process
Payer Correspondence follow up
Document accounts in the Epic system for correspondence, follow up and outgoing mail.
Managing the intake and separation of incoming mailed correspondence from insurance payers, ensuring documentation is properly reviewed and accurately batched for scanning.
Serving as a liaison for Insurance Claim Specialists by coordinating outgoing mail and faxes to patients and insurance payers.
Reviewing and evaluating paper claims, analyzing claim information for appropriate mailing.
Demonstrating a thorough understanding of insurance processes and requirements.
Possessing strong analytical skills to evaluate large volumes of data and identify patterns or trends related to insurance payer demographic updates.
Any other duties outlined by the department
Qualifications:
Education
High School Diploma/Equivalent
Job Qualifications:
2+ year's experience in insurance claims processing and support
Knowledge of insurance policies and claim adjudication
Experience investigating and resolving claim issues
Strong communication and customer service skills
Ability to maintain detailed records and ensure compliance
Preferred Qualifications:
Experience working with Availity insurance system
Requires a minimum of six months of billing experience in a hospital and/or physician’s office, OR at least one year of experience in a business setting involving finance, accounting, or insurance portal systems.
Ability to accurately verify patient insurance eligibility
Prefer experience working with commercial and government payers, including BCBS, Medicare, Medicaid, and other third-party insurance carriers.
Must have above-average math skills and be proficient with a calculator.
Demonstrated ability to communicate effectively with others and to work independently under pressure while consistently achieving desired results.
Must be able to interact effectively with the public and exercise good judgment in resolving accounts.
Knowledge of medical terminology is preferred.
Experience with computerized insurance billing systems and Microsoft programs is preferred.
Epic experience is required.
Working effectively under pressure while maintaining accuracy and attention to detail.
Numbers & Facts
Location
Gainesville, Florida
Job Type
Full-time
Skills
Accountingunmatched
Adjudicationunmatched
Administrative Skillsunmatched
Analysis Skillsunmatched
Billingunmatched
Calculatorsunmatched
Claims Managementunmatched
Claims Processingunmatched
Communication Skillsunmatched
Customer Support/Serviceunmatched
Data Analysisunmatched
Demographicsunmatched
Detail Orientedunmatched
Documentationunmatched
Epic Systemsunmatched
Fax Machinesunmatched
Financeunmatched
Financial Servicesunmatched
Governmentunmatched
Hospitalunmatched
Insuranceunmatched
Insurance Claimsunmatched
Maintain Complianceunmatched
Mathematicsunmatched
Medicaidunmatched
Medical Officeunmatched
Medical Recordsunmatched
Medical Terminologyunmatched
Medicareunmatched
Microsoft Windows System Internals/Programmingunmatched
Negotiation Skillsunmatched
Problem Solving Skillsunmatched
Record Keepingunmatched
Regulatory Requirementsunmatched
Return on Investment (ROI)unmatched
Third-Party Payerunmatched
Time Managementunmatched
Trend Analysisunmatched
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