Insurance Reimbursement Specialist

Operations · Torrington, Connecticut
Department Operations
Employment Type Full-Time
Minimum Experience Entry-level

Insurance Reimbursement Specialist


This is an exciting opportunity to join a rapidly growing company!


PRIA Healthcare Management is a patient access and reimbursement solutions company specializing in patient based appeals of denied care. We are currently looking for an Insurance Reimbursement Specialist that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service. 


Experience working with insurance appeals and the prior authorization process is preferred. Knowledge of medical reimbursement policies within a healthcare organization is preferred. Previous Medical Billers and Certified Coding Specialists are a plus. 

 

In addition to a well-rounded benefits package, Paid Time Off, Medical/Dental/Vision and 401(k), we also offer our employees training opportunities including tuition reimbursement, career development courses and employee referral programs.

 

But wait, there’s more… culture is what unites us. We are proud of the environment we have built that defines our culture and focuses on keeping our employees engaged, healthy, happy and motivated. We have committees that meet regularly to develop creative ideas to plan fun activities, volunteer work days and to promote wellness.

 

PRIA Healthcare was recognized as one of the Best Places to Work in Connecticut in 2020!


Job Responsibilities:


  • Entering patient accounts in system database
  • Submission of prior authorizations/appeals of national payers
  • Provide review at all levels of an insurance appeal
  • Gather supporting documentation (i.e. state protocols, physician/hospital medical records, state or federal statutes, patient/physician letters, etc.)
  • Interactions with utilization review/management departments
  • Provides exceptional customer service to patients and providers 
  • Understands and tracks adverse denial trends and presents them to management
  • Researches payer statutes, regulations, and regional requirements
  • Comply with HIPAA laws and company policies and procedures
  • Other duties as assigned



Required Skills: 


  • Experience working with insurance claims, appeals, prior authorization and utilization review is preferred but not a must
  • College degree preferred but will substitute for applicable work experience
  • Experience with Medicare, Medicaid, Tricare, Workers Compensation and Commercial Insurance
  • Must demonstrate the ability to draft professional and effective appeal letters
  • Expertise in CRM software is a plus
  • Must have solid knowledge of patient account systems and ability to troubleshoot and suggest improvements
  • Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees 
  • Knowledge of general office procedures and use of office equipment
  • Must be proficient in Microsoft Office (Word and Excel)
  • Must demonstrate excellent communication skills, verbal and written.

 

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  • Location
    Torrington, Connecticut
  • Department
    Operations
  • Employment Type
    Full-Time
  • Minimum Experience
    Entry-level