CBO Insurance Resolution Specialist

Insurance Resolution Specialist

The Insurance Resolution Specialist handles and resolves all insurance billing follow-up and denial issues to ensure that the Medical Center receives correct reimbursements from insurance companies. They are responsible for ensuring that all billed claims comply with federal and state requirements, as well as payer-specific guidelines. The incumbent serves as the liaison between insurance companies, patients, and departments to ensure claims are processed and followed up on to meet the Medical Center's goals for account receivable days, aging account percentages, and cash goals.

The specialist researches and responds to questions and complaints regarding patient responsibility balances and billing inquiries through the customer call center with professionalism and courtesy. They utilize multiple electronic billing systems, payer websites, and medical billing and coding guidelines to resolve insurance denials and guarantor/patient inquiries. The representative must be able to respond knowledgeably to a wide range of billing and denial issues when dealing with insurance companies. The goal is to resolve billing and denial issues through positive communication with insurance companies, patients, and internal teams.

Key Responsibilities

1. Perform inpatient and outpatient billing processes.
2. Follow up on insurance denials and resolve related issues.
3. Manage insurance billing, payments, collections, and processes, leveraging knowledge of revenue cycle management.
4. Provide excellent customer service to inquiries from insurance companies, UVA departments, and patients.
5. Analyze patient accounts to identify issues and opportunities for resolution.
6. Support department functions to achieve organizational goals.
7. Perform additional duties as assigned.

Position Details

Compensation Range: $16.64 - $25.79 per hour

Minimum Requirements

• High School diploma or equivalent.
• At least 1 year of relevant experience.
• No licensure required.

Physical Demands

This role requires prolonged sitting, with proficient communication, auditory, and visual skills. Attention to detail and legibility in writing are essential.

The University of Virginia, including UVA Health System, is committed to diversity and equal opportunity employment. All qualified applicants will receive consideration without regard to age, race, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, religion, sex, pregnancy, sexual orientation, veteran or military status, or genetic information.