Customer Experience Administrative Insurance Specialist

Note: The content below preserves the original job information and improves structure and accessibility while removing formatting issues.

Education: Minimum of an Associate’s Degree required with two years of experience in a behavioral health or medical office setting with experience in front desk operations, billing, and customer service required.

Experience: Three years or more experience in a healthcare setting, knowledge of admission requirements in a healthcare setting. Exceptional knowledge of Net Smart Avatar or other electronic medical records, working with Medicare, Medicaid and third party outpatient insurance claims and denials utilizing an EHR. Must possess knowledge of ICD-10CM, CPT and HCPCS, including coverage levels, rules/regulations, fee schedules and contracted services.

Demonstrated understanding of quality assurance and monitoring of reports; ability to work autonomously while maintaining proactive communication with supervisor and other departments. Ability to demonstrate strong organizational skills. Excellent customer service abilities, excellent written and verbal communication skills, and cultural competence skills; ability to work effectively with a multi-disciplinary team in a fast-paced, changing environment.

Additional Requirements:

Must be 21 years of age or older.

Negative Drug Screening prior to hire and throughout employment.

Clear Criminal Background Check throughout employment with Suncoast Center and local checks prior to hire and annually along with DCF Level II prior to hire and as required by DCF, and Must have valid Florida Driver’s License Motor Vehicle checks prior to hire and annually with acceptable driving record maintained throughout employment along with reliable vehicle, valid registration, and valid vehicle insurance.

(must be in compliance with Florida Laws and Administrative Codes with fingerprinting and determined to be of good moral character).

Work schedule may vary according to department demands. Work is performed indoors office based at a Community Mental Health Agency in Pinellas County.

Must be proficient with Microsoft Word, Outlook, and Excel. Must be proficient with electronic medical record systems including admissions, financial enrollment, and website portal navigation, Electronic Health Record comprehension, Net Smart Avatar experience a plus.

• Complete all daily, weekly, and monthly Avatar management reports related to agency-wide admissions, guarantor set-up, and insurance changes.
• Answer client phone calls, updating client accounts and addressing client issues regarding finance/billing issues.
  • Work closely with Authorization specialist to ensure authorizations are processed in an accurate and timely fashion.
  • Monitor reports daily, weekly, monthly related to admissions, guarantor/insurance changes to correct/verify client financials: ensuring accuracy.
  • Complete and monitor client insurance verification to ensure accurate guarantor set-up during the enrollment period and update periods when required.
  • The Reimbursement, Central Intake, Enrollment, and Utilization Departments work together to ensure client information is entered and updated for all clients in the electronic medical record system (Avatar).
  • Coordinate with the department managers in the screening, and interviewing of new hires for the department.
  • Work as a cohesive team member focused on a common goal to ensure accuracy of the insurance information to maximize revenue.
  • Other duties may include data entry of insurance data, addressing denied or rejected claims, investigating coding issues, updating client records and making sure of overall billing compliance in line with insurance guidelines and regulations.
  • Participate in access, billing, and other system coordination meetings as needed.
  • Work as a cohesive team member focused on a common goal.
  • Other Duties as Assigned

• The ability to function and operate as a team player, showing dignity and respect for all.
• The ability to comply with all equal employment opportunity and ethical standards and regulations.
• The ability to take direction in a respectful and productive manner from supervisors and managers.
• The ability to work, as scheduled, in a timely fashion, and with an attitude oriented to service.
• The ability to have cordial and professional relationships both within the organization and with vendors, clients and third parties.
• If appropriate, the ability to produce all appropriate paperwork and reports consistent with contractual, state or federal standard, and to prepare and submit such paperwork on a timely basis.
• The ability to understand and comply with Suncoast Center, Inc. policies and procedures.
• The ability to render compassionate care and equal commitment to serve clients in need of healthcare assistance.