Insurance Analyst at SSI Group in Mobile, Alabama

Job Description:

Purpose of Position


Responsible for managing medical insurance claims, billing processes, and data entry to ensure accurate reimbursement, compliance with healthcare regulations, and resolution of claim discrepancies. This role involves submitting claims, handling denials, verifying patient insurance, and maintaining accurate records.



Duties and Responsibilities



Essential Functions

• Process, review and submit insurance claims to third-party payers (Medicare, Medicaid, private insurers) based on medical coding, billing data, and patient insurance information.

• Ensure that claims are complete, accurate, and compliant with payer-specific rules and guidelines.

• Investigate and analyze denied claims, identifying the cause of denials (e.g., coding errors, missing documentation, eligibility issues).

• Work with coding and clinical teams to resolve issues and resubmit claims for payment.

• Appeal denied claims and work to ensure that payments are received promptly.

• Review insurance company remittance advice (EOBs) to confirm payments are consistent with the terms of the payer contract.

• Resolve discrepancies between billed amounts and paid amounts, ensuring accurate adjustments and patient responsibility.

• Communicate with payers to resolve any outstanding payment issues.

• Ensure proper verification of patient insurance eligibility and benefits prior to service delivery.

• Confirm that required pre-authorizations or referrals are obtained for specific procedures, treatments, or hospital admissions.

• Track and report on key performance indicators (KPIs) related to claims processing, such as claim approval rates, denials, and aged accounts.

• Generate reports to identify trends in claims issues, payer performance, and payment delays.
• Post insurance and patient payments accurately into billing systems and reconcile transactions to ensure proper allocation.

• Stay up-to-date with changes in healthcare regulations, payer policies, and billing codes (ICD-10, CPT, HCPCS).

• Ensure that the department remains compliant with federal, state, and payer-specific billing requirements, including HIPAA.

• Assist patients and other stakeholders with insurance-related inquiries, helping to explain coverage issues, billing questions, or denials.

Marginal Functions

• Other duties as assigned

Skills, Knowledge, and Abilities

• Experience in healthcare billing or revenue cycle management, with a solid understanding of insurance processes and claim handling.

• Strong analytical and problem-solving abilities.

• Knowledge of insurance terminology, healthcare regulations, and payer-specific guidelines.

• Familiarity with billing software and electronic health record (EHR) systems.

• Excellent communication skills, both written and verbal.

• Attention to detail and ability to prioritize tasks in a fast-paced environment.

• Proficiency with Microsoft Office suite

Security Roles and Responsibilities

• Implement and act in accordance with the organization's information security policies;
• Protect assets from unauthorized access, disclosure, modification, destruction or interference;
• Execute particular security processes or activities;
• Ensure responsibility is assigned to the individual for actions taken; and
• Report security events or potential events or other security risks to the InfoSec department.

Experience and Education Requirements



Education



Min/Preferred



Education Level



Description


Minimum

High School or GED

High school diploma or equivalent required.

Preferred

2 Year / Associate Degree

Associate's degree in Healthcare Administration, Business, or a related field preferred.



Years of Experience



Minimum Years of Experience



Comments


2

2+ years of experience with medical billing required.



Certifications



Min/Preferred



Certification



Description



A combination of experience and advanced education may be substituted. Background checks and drug test required. Apply Now