Sr Insurance Specialist - Commercial/Blue Cross Job Listing at Holyoke Medical Center in Holyoke, MA (Job ID 9683)

Description

Disclaimer for Job Postings Note: The compensation range noted above represents the base salaries for all positions at a given grade across#the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidate#s relevant experience. No employee will be paid below the minimum of the range. # Holyoke Medical Center is looking for a Sr Insurance Specialist.# This position manages complex medical claims, acting as a subject matter expert to investigate, adjudicate negotiate#settlements, ensure compliance and mentor junior staff, focusing on accurate and timely and cost-effective claims resolution while#maintaining strong communication with providers, payers and internal#teams. Works all claims as assigned/directed. DUTIES AND RESPONSIBILITIES:  Serve as subject matter expert, providing guidance on policy, regulations and complex#claims scenarios.  Conduct in-depth analysis, research discrepancies, prevent fraud and develop plans for#claims resolution.  Handles escalated inquires, build relationships with providers/payers and communicate#claims status.  Assist in training, coaching and provide senior support to less experienced team#members.  Review and process complex hospital claims and determine coverage based on policy,#medical necessity and contracts.  Able to work all aspects of Commercial Managed Care, Medicare Advantage, and#Medicaid Advantage Care accounts sliding between Financial Classes as needed for#Billing, Follow-up, Denials Management, Credit Balance and Account resolution. Required Skills  Must show honesty, integrity, strong ethics, data entry skills and time management skills  Insurance follow up experience especially Blue Cross and all Commercial Lines  Strong understanding of Medetech and finThrive billing programs  Strong Verbal and written skills for preparing and presenting appeals, negotiating settlements#and presenting reports to Senior Management.  Proactive approach to resolving discrepancies between insurance policy terms and provider#charges  Ability to analyze complex data, identify issues and solve problems  Proven background in handling complex institutional or healthcare related claims  Proficiency with claims software and MS Office (especially Excel).  Strong time management, organization skills and ability to work independently or in a team  Good plus knowledge of ICS/HCPCS/CPT Coding and medical terminology  Knowledge of commercial, state and federal healthcare regulations  Excellent Math Skills and knowledge of general accounting principals  Ability to logically and accurately organize data  Excellent problem solving skills  Strong attention to detail # QUALIFICATIONS/JOB REQUISITES: Education: High School Diploma or GED is required, an Associate or Bachelor#s degree in Health#Administration or related Study preferred # Experience: Eight plus (8+) years in the health insurance, hospital business office or claims#processing/management.