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Top 50 Health Insurance Specialist Skills

Below we've compiled a list of the most important skills for a Health Insurance Specialist. We ranked the top skills based on the percentage of Health Insurance Specialist resumes they appeared on. For example, 19.0% of Health Insurance Specialist resumes contained Insurance Companies as a skill. Let's find out what skills a Health Insurance Specialist actually needs in order to be successful in the workplace.

These are the most important skills for a Health Insurance Specialist:

1. Insurance Companies

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high Demand
Here's how Insurance Companies is used in Health Insurance Specialist jobs:
  • Coordinated benefits operations with internal and external business partners including employers, third-party vendors and insurance companies.
  • Prepared and maintained patient insurance information in the computer system and coordinated with insurance companies.
  • Communicate with patients, providers and insurance companies regarding coverage and reimbursement issues.
  • Prepared and submitted claims to various insurance companies either electronically or by paper.
  • Obtained authorizations from insurance companies for inpatient and outpatient procedures.
  • Obtain Pre-Certifications from health insurance companies for inpatient encounters.
  • Performed Level-of-Care follow up-changes and contacted pertinent insurance companies.
  • Answer questions from patients, clerical staff, and insurance companies, as well as identify and resolve patient billing complaints.
  • Re-Billed and Re-filed claims to the correct insurance companies Billed patients for their office visits, when patient's responsibility.
  • Worked for Independence Blue Cross/Blue Shield, and Anthem Insurance companies (as a temporary-with Corporate Call Center).
  • Assist in preparing, reviewing and following through to completion on health insurance submissions to the insurance companies.
  • Initiate inquiries with insurance companies to determine why bills have not been paid.
  • Interact with patients and third party insurance companies to secure retroactive insurance coverage.
  • Seek prior authorization for certain procedures that require it from insurance companies.
  • Acted as the primary contact between doctors and insurance companies.
  • Contacted insurance companies to verify health insurance for billing.
  • Interact with primary, secondary and tertiary third-party insurance companies.Review, confirm and posted insurance payments.
  • Resolve patient complaints or explain why certain prescription Work directly with healthcare providers, patients and insurance companies.

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2. Health Insurance Plans

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high Demand
Here's how Health Insurance Plans is used in Health Insurance Specialist jobs:
  • Manage 300 individual health insurance plans including Medicare supplement and advantage policies.
  • Quoted group and individual health insurance plans from various major health insurance carriers for new and existing clients.
  • Assisted customers with health insurance plans and applications to facilitate prospective member s understanding of policies.
  • Manage pension, annuity and health insurance plans for approximately 3,000 union members.
  • Worked with CMS 1500 claims, UB-04 claims, Health insurance plans.
  • Sell Medicare health insurance plans to prospects aged 65 and older.
  • Handled paper applications for individual & family health insurance plans Data entry, project management HEALTHCARE (4 years)

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1 Health Insurance Plans Jobs

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3. Insurance Policies

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high Demand
Here's how Insurance Policies is used in Health Insurance Specialist jobs:
  • Succeeded in selling individual health insurance policies.
  • Implemented effective marketing plans, sales initiatives, and servicing of all individual health insurance policies, including tracking reports.
  • Update patients E2569 forms in Composite Health Care System (CHCS) and patient s address and insurance policies.
  • Input all health insurance policies into data base (CHCS and TPOCS) which were both Oracle based programs.
  • Verified other health insurance policies using medical billing software TPOCS (Third Party Outpatient Clinic System).
  • Verified and reviewed other health insurance policies for veterans, retirees and dependents of military personnel.
  • Marketed, sold and serviced Medicare supplement insurance policies; created and maintained computer files
  • Advised different life and health insurance policies to prospective clients.
  • Explained various insurance policies and helped clients choose appropriate plans.
  • Verified other health insurance policies using medical billing software TPOCS.
  • Committed to excellent service with in-depth knowledge of insurance policies.
  • Analyzed existing insurance policies and explained details to the insured.
  • Answered questions and inquiries regarding health insurance policies.
  • Process and record new insurance policies and claims.
  • Assist Medicare beneficiaries to understand their benefits, complete required paperwork Make changes to existing insurance policies to meet customer needs.

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4. Medicaid

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high Demand
Here's how Medicaid is used in Health Insurance Specialist jobs:
  • Analyze Medicaid and section 1115 policies, precedence and operations to evaluate appropriateness, effectiveness, cost-effectiveness and/or other impacts.
  • Participate in, and provide specific and detailed information regarding operational policy, instructions and procedures for Medicaid programs.
  • Delivered oral presentations at National Association of Rural Health Clinics Conference and Medicaid Managed Care Regional Training Conferences.
  • Developed a Staffing Waiver monitoring contrivance to assist Rural Health Clinics in obtaining Medicare/Medicaid certification.
  • Certified Illinois hospitals and rural health clinics seeking provider status in the Federal Medicare/Medicaid Program.
  • Possessed operational and policy knowledge of eligibility and enrollment functions for Medicaid and CHIP.
  • Investigated claims of Medicare/Medicaid billing abuse by participants seeking reimbursement for services rendered.
  • Monitor and evaluate state Medicaid programs for compliance with Federal regulations.
  • Supported Centers for Medicare and Medicaid Services Senior Management.
  • Evaluate the effectiveness of existing policies and reviews new policy and legislative initiatives for potential impact on the Medicaid programs.
  • Develop policies and procedures to track and report PERM improper payment recoveries of federal matching Medicaid and CHIP expenditures.
  • Subject matter expert for Medicaid and home and community based services for people with disabilities and older adults.
  • Performed extensive coordination with divisions within HHSC such as Medicaid-CHIP division and HHSC and vendor Policy divisions.
  • Provided training to State Medicaid programs regarding integrity issues specific to the state or nationally.
  • Conducted benefits investigation, including Major Medical, PBM, Medicare & Medicaid.
  • Assisted members with Medicare and Medicaid inquiries.
  • Coordinate and conduct a variety of broad range analytical studies and projects dealing with Medicaid eligibility.
  • Measured improper payments in Medicaid based on reviews of states eligibility determinations of applicants and recipients.
  • Assisted customers with their application and determining eligibility for premium tax credits and Medicaid.
  • Adhered to company and HIPAA regulations in order to stay in compliance with the Center for Medicare and Medicaid Services regulations.

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5 Medicaid Jobs

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5. Customer Service

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high Demand
Here's how Customer Service is used in Health Insurance Specialist jobs:
  • Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems.
  • Maintain quality control/satisfaction records, constantly seeking new ways to improve customer service.
  • Addressed situations escalated from less experienced customer service specialists.
  • Provide excellent customer service and professional insurance advice.
  • Helped in training new customer service representatives.
  • Maintained overall customer service of membership.
  • Provided Customer Service to potential members.
  • Perform audits on Customer Service Representatives and claims processing team and provide coaching, feedback, and performance enhancement recommendations.
  • Worked on three-person team that developed, tracked and implemented the Provider Customer Service Training Pilot.
  • Trained Customer Service Reps on registration processes and how to work all denied claims by insurance.
  • Interviewed clients and received their calls to provide customer service in obtaining information on their accounts.
  • Processed insurance claims, while maintaining a high level of customer service.
  • Utilized excellent customer service skills to achieve a degree of customer satisfaction.
  • Provided customer service in the area of health insurance.
  • Chase Bank- Customer service not limited to accurately handling monetary, non-monetary transactions while entering information into respective database.
  • Serve as the liaison between customers/verification/agents/customer service department - Build and maintain clientele through referral market (avg 50-90 clients/week)
  • Last take every customer service call in regards to clients who are already enrolled.
  • Used and Maintained a Customer Service Management System to organize over 1000 cliental.
  • Processed various medical and dental claims * Reviewed and arranged claims into respective categories * Provided excellent customer service
  • Maintain the highest level of integrity, courtesy, and respect Handle other duties as assigned Skills Used Customer Service Data Entry

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6. Technical Assistance

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Here's how Technical Assistance is used in Health Insurance Specialist jobs:
  • Identify opportunities for other technical assistance to the States and develops methods and procedures to effectively provide such technical assistance.
  • Provide technical assistance to Michigan and Minnesota on Home and Community Based Waivers and Medicaid eligibility issues.
  • Provide policy leadership and technical assistance to states by supporting system-wide payment and delivery system reform innovation.
  • Developed training and technical assistance plans for Medicare health plans' implementation of payment operations.
  • Provide technical assistance and business services to support surgery services, central offices, and patient care support.
  • Attend meetings to learn about new products and services, learn new skills, and receive technical assistance.
  • Lead regular demonstration meetings to provide technical assistance and guidance to state and other federal partners.
  • Provide technical assistance and policy guidance to States on Marketplace enrollment.

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7. CMS

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Here's how CMS is used in Health Insurance Specialist jobs:
  • Insured compliance of CMS regulatory standards and policies for participating provider Hospitals in Illinois.
  • Participated development of CMS policy, including implementing regulations and administrative actions.
  • Respond to eligibility questions requiring clarification from CMS.
  • Experience with Medicare and Medicaid insurances pertaining to CMS guidance, state eligibility, and private health plan operations and protocols.
  • Create original content and other appropriate products, to further CMS' organization, programmatic, and policy-based missions.
  • Served as a Legislative Analyst in the CMS Legislative Office over Medicaid issues, while responding to Congressional inquiries.
  • Mentored employees and students to enhance their skills, training and abilities within CMS for permanent and promotional opportunities.
  • Maintained liaison with beneficiaries, providers, organizations, and contractors ensuring that continuous improvements were made to CMS.
  • Identify requirements and supervise contractor's work in developing CMS' central data abstraction tool (CDAT).
  • Serve as a CMS representative on advisory boards, technical expert panels, forums and stakeholder meetings.
  • PERM eligibility component liaison for the Provider Compliance Group to other components within and outside of CMS.
  • Managed home- and community-based service (HCBS) waivers for CMS Region 3.
  • Analyzed proposals, developed substantive comments and recommendations for states and CMS leadership.
  • Extracted data and download documents from the HPMS for CMS policy processes.
  • Received CMS Administrator's Special Citation Award for these efforts.
  • Prepared responses to public comments on CMS policies.
  • Assist with agency website updates into Percussion for CMS.gov/outreach-and-education/training/ cmsnationaltrainingprogram/ Approve postings.
  • Collaborate and partner with contractors and CMS staff that oversee Enterprise Identity Management (EIDM) and Enterprise Portal; 4.
  • Served as co-chair for ZPIC/state/CMS steering committee and coordinated and attended quarterly onsite meetings.
  • Provide regular correspondence and guidance to CMS Regional AIM CORs who work directly with QIOs.

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7 CMS Jobs

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8. Providers

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high Demand
Here's how Providers is used in Health Insurance Specialist jobs:
  • Contacted insurance providers to verify correct insurance information and get authorization for proper billing codes.
  • Assisted insurance providers for the purpose of verifying eligibility of insurance claims.
  • Verified benefits and eligibility for providers and members.
  • Provide effective explanations of benefits, procedures, claim status, or payment information to beneficiary and providers.
  • Resolved complex problems from members, providers and other areas that could not be resolved through normal channels.
  • Process insurance claims, insurance verification, faxing out forms and processing overrides for providers and pharmacies.
  • Assisted providers with co-pays and co-insurances due at the time of customer's visits to providers.
  • Connect consumers to service providers, advocate for and support consumers as they navigate.
  • Provided consultancy to Georgia Medicaid members and providers in high volume call center.
  • Team lead for the transition to ICD-10-CM reporting for home health providers.
  • Communicate with health insurance providers to ensure medical claims process smoothly.
  • Communicate with other medical staff and health insurance providers often.
  • Reviewed and explained member benefits to medical groups and providers.
  • Acted as the primary contact between the corporation and members/providers.
  • Assisted members with the location of in-network providers and facilities.
  • Followed up on outstanding claim balances for 30 different providers.
  • Close interaction with Medical Case Managers and Providers.
  • Authorized referrals to contracted outpatient providers according to client's Employee Assistance Program and behavioral healthcare insurance benefits.
  • Provided educational services to healthcare providers, pharmacy staff, and patients requesting access to specialized medications.
  • Conducted pre-verification for providers on customers insurance coverage.

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9. Medicare

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high Demand
Here's how Medicare is used in Health Insurance Specialist jobs:
  • Developed, evaluated, implemented, and managed Medicare quality measurement and public reporting efforts in the hospital and outpatient settings.
  • Provide assistance related to health insurance benefit options including Medicare eligibility and enrollment.
  • Provided technical guidance to five national accreditation organizations' Medicare Deeming programs.
  • Collaborated with lead policy analysts on Medicare manual instructions.
  • Identify, analyze, prioritize, and resolve issues and problems relating to the operation and management of the Medicare program.
  • Utilize teamwork skills to translate Medicare policy into data system rules and claims edits with a team of billing experts.
  • Use expert knowledge of Medicare and Insurance industry to walk potential clients through a broad range of insurance carriers.
  • Managed the Medicare Prescription Drug Benefit Program Mark License Agreement process while implementing the program into the HPMS.
  • Contributed as a federal career intern within the Division of Medicare Financial Management for the Program Integrity Branch.
  • Assist the team with any questions and concerns during the enrollment or plan change process regarding Medicare.
  • Key regulations were Medicare Part D Data, Medicare Prescription Drug Discount Card.
  • Researched and assisted in the development of an instruction on Medicare appeals.
  • Conducted analytical studies of reporting requirements for specific Medicare programs.
  • Managed million dollar budgets for Medicare Secondary Payer contractors.
  • Conducted presentations & outreaches on Medicare Parts A, B, C, D; Medigap; and Managed Care Plans.
  • Coordinated the Medicare Part D Assessment and Monitoring of the Utilization of Prescriber National Provider Identifiers.
  • Assisted in enrollments for Medicare Part D, Medigap Policies, and Managed Care Plans.
  • Provided analytical support in managing the close of the Medicare Health Support demonstration.
  • Collaborated in a multi-office workgroup about a proposed Medicare ambulance regulation.
  • Implemented the "True Out-of-Pocket" (TrOOP) provisions of the Medicare Prescription Drug Improvement and Modernization Act of 2003.

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5 Medicare Jobs

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10. Oversight

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high Demand
Here's how Oversight is used in Health Insurance Specialist jobs:
  • Developed, implemented, provided oversight and monitoring activities of Medicare Part D claim integrity audits.
  • Conduct audits, application reviews, and marketing oversight for organizations in compliance with Federal regulations.
  • Managed, supervised, and approved the oversight of the reapplication/application filing process for providers and suppliers seeking Medicare Deeming status.
  • Served as a Team Leader with direct oversight of the Sanctions Program.
  • Make recommendations on operationalization and oversight of specific marketplace enrollment policies.
  • Chaired the Medicaid managed care workgroup that developed fraud and abuse safeguard were developed to assist with oversight of network providers.

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11. Officer Representative

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high Demand
Here's how Officer Representative is used in Health Insurance Specialist jobs:
  • Serve on Contract Officer Representative Panel and prepare business and technical evaluation proposals.
  • Experience working with MARMC mission; operational goals and objectives in relation to contracting officer representative duties.
  • Certified as a Contracting Officer Representative (COR) Level II managing multi-million dollar contracts.

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12. Phone Calls

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high Demand
Here's how Phone Calls is used in Health Insurance Specialist jobs:
  • Handled all incoming appeals that were received via emails; answered and received phone calls from members pertaining to appeals.
  • Answered phone calls enrolling clients in Family medical leave and short term disability
  • Handled inbound phone calls from clients.
  • Obtain claim status via telephone calls.
  • Handled incoming phone calls/e-mails regarding health and commuter insurance for various companies with a high level of customer retention.

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1 Phone Calls Jobs

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13. Data Entry

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high Demand
Here's how Data Entry is used in Health Insurance Specialist jobs:
  • Perform various administrative duties as assigned including data entry.
  • Process data entry activities of pertinent information received at different points of contact during the delivery of program services.
  • Perform data entry of imaged documents received through the New York HealthBenefit Exchange.
  • Perform all of my own Marketing, Prospecting, and Data Entry.

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14. Hipaa

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high Demand
Here's how Hipaa is used in Health Insurance Specialist jobs:
  • Handled diverse phone calls and confidential information following all HIPAA guidelines.
  • Earned HIPAA compliance to view and handle confidential patient medical charts.
  • Adhered to mandatory HIPAA privacy, Business Ethics and Compliance programs.
  • Well versed in HIPAA and 'Section 508 compliance' standards.
  • Develop policies and procedures for compliance with HIPAA.
  • Complete seminars in HIPAA privacy and administration.
  • Complied with HIPAA security and privacy regulations.
  • Maintained working knowledge of HIPAA regulations.
  • Adhered to HIPAA policies and procedures
  • Provide authoritative advice regarding HIPAA compliance and implementation in regards to the organizations processes.

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15. Marketplace

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Here's how Marketplace is used in Health Insurance Specialist jobs:
  • Review, analyze and monitor Medicare contractor and Marketplace issuer performance metrics for compliance with federal performance standards.
  • Resolved complaints for Medicare beneficiaries and Marketplace consumers.
  • Created and maintained training materials for the New York State of Health Marketplace supervisors and their teams.
  • Facilitate health insurance plan quality monitoring and improvement strategies for the Health Insurance Marketplace in Arkansas.
  • Planned and participated in community-wide events to educate the public on the Health Insurance Marketplace.
  • Perform outreach on the Affordable Care Act and more specifically the Marketplaces.
  • Assisted consumers in enrolling into the Health Insurance Marketplace.
  • Facilitated the development and execution of Employer Open Door Forum to reach employers interested in Marketplace healthcare for their employees.
  • Research,process and present quantitative data on marketplace enrollment for specific segments of the U.S. population as assigned.

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3 Marketplace Jobs

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16. ACA

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Here's how ACA is used in Health Insurance Specialist jobs:
  • Assist in keeping up to date on information for carrier and governmental policies and the ACA (Affordable Care Act).
  • Drafted legal regulations and regulatory text for the ACA 3008 HAC Reduction and ACA 3025 Hospital Readmission Reduction Payment Programs.
  • Develop and draft ACA related policies, regulations, procedures, guidance, correspondence, and other related documents.
  • Develop and implement quality rating and improvement systems for the private health insurance market and ACA related programs.
  • Maintained working knowledge of complex insurance laws including but not limited to ACA and COBRA.
  • Perform program monitoring and oversight of the private health insurance market and ACA related programs.
  • Subject matter expertise in employer sponsored insurance requirements (ACA).
  • Have kept abreast & written ACA compliant plans.
  • Have transitioned NGF & GF Health plans to ACA.
  • Perform ad hoc tasks to assist region counterparts in the implementation of ACA rules regarding state preparedness and systems adjustments.
  • Worked as an authorized independant ACA agent during 2014, 2015, and 2016 seasons.
  • Timed the healthcare revolution perfectly, enrolled hundreds in Obamacare, with a 20% closing ratio.

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17. Medical Records

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Here's how Medical Records is used in Health Insurance Specialist jobs:
  • Reviewed hospital and nursing home medical records and interviewed Medicare beneficiaries in the development of investigations.
  • Protected the security of medical records to ensure that confidentiality is maintained.
  • Performed audit review of patient medical records monthly for current TPC, OHI DD form 2569.
  • Maintain medical records, technical library, or correspondence files.

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18. Hippa

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Here's how Hippa is used in Health Insurance Specialist jobs:
  • Maintained confidentiality of all information according to HIPPAA and Privacy ActGuidelines.
  • Engaged in data processing, error correction and handled sensitive information in compliance with HIPPA regulations for clients.
  • Complied with HIPPA privacy regulations and maintained confidentiality at all times.
  • Comply with HIPPA rules, regulations and all hospital policies.
  • Follow all applicable HIPPA and privacy regulations.
  • Adhered to HIPPA and medical protocol for proper release of information maintaining a secure operational environment.

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19. State Regulations

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Here's how State Regulations is used in Health Insurance Specialist jobs:
  • Evaluated the impact of federal and state regulations have on health equity and developed policy recommendations that reduce disparities.

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20. Life Insurance

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Here's how Life Insurance is used in Health Insurance Specialist jobs:
  • Assist prospective clients chose the proper type and amount of life insurance that suited their needs.
  • Licensed Enrollment Specialist for health, accident, and life insurance.
  • Licensed to sell health and life insurance in 45+ states.

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21. Regional Office

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Here's how Regional Office is used in Health Insurance Specialist jobs:
  • Provided direction to regional offices and Medicare contractors on provider education and training initiatives regarding specific education/training issues as they arise.
  • Coordinate training initiatives for CMS central/regional office staff and external partners.
  • Conducted joint Central Office and Regional Office conference meetings to develop national policy for tracking staffing waivers.
  • Provided policy guidance to CMS Regional Offices to support state compliance and enforcement efforts.
  • Coordinate with CMS Regional Offices for MEQC program administration.
  • PERM Recoveries Liaison- Coordinate with CMS Regional Offices for recoveries of improper payments for PERM.
  • Provide expert and authoritative advice to Regional Office Account Managers and Pharmacists on formulary compliance issues and matters involving operational policy.

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22. New Clients

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Here's how New Clients is used in Health Insurance Specialist jobs:
  • Seek out new clients and develop clientele by networking to find new customers and generate lists of prospective clients.
  • Maintained existing clients needs and also generated new clients.

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23. COR

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Here's how COR is used in Health Insurance Specialist jobs:
  • Recorded information exchange and entered patient s information in an organizational database.
  • Research records, reconstruct incorrect information to prepare insurance billing.
  • Reviewed records for completeness, accuracy and compliance with regulations.
  • Maintain confidentiality of all information according to HIPAA guidelines.
  • Correct documents to facilitate payment.
  • Analyze claimant data by utilizing all verification resources and determining the correct course of action to resolve errors.
  • Identify root causes of diminished cycle progress and work with the appropriate individuals to develop corrective actions.
  • Developed and wrote the current guidelines for transferring medical insurance bills from electronic records to paper copies.
  • Respond to correspondence and telephone inquiries generated by third party insurance carriers, beneficiaries and others.
  • Attend to both inbound and outbound telephone calls/contacts in accordance with the standard operating procedures.
  • Research into accounts, perform appropriate financial transactions and account adjustments to correct problems.
  • Resolved first level support issues and identified next level of support accordingly.
  • Assist Medicare members with their accounts in accordance with CMS guidelines.
  • Maintained HIPPA guidelines when handling members' personal records and information.
  • Assist Medicaid members in accordance with ACHA guidelines.
  • Review and correct all electronic billing edit reports.
  • Attained record sales in one month.
  • Research and reconcile incorrect payment for improper reimbursement.
  • Transmit data records to FDA and/or third party submitters.
  • PERM Review Contractor Contracting Officer Representative (COR)- Effectively monitors contractor performance and ensure timely completion of deliverables.

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24. Outbound Calls

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25. HHS

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Here's how HHS is used in Health Insurance Specialist jobs:
  • Participated in all trainings, as assigned by the Department of Health and Human Services (HHS).
  • Reviewed and provided comments to documents going through the HHS and CMS clearance process.

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26. Icd-9

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Here's how Icd-9 is used in Health Insurance Specialist jobs:
  • Utilized the knowledge of ICD-9 codes used for verification of inpatient/observation authorizations.
  • Lead liaison on the International Classification of Diseases, 9th Edition (ICD-9) Automated Load project.
  • Worked with the Multi-Carrier System to automate the ICD-9 update for the Part B MACs.

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27. CPT

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Here's how CPT is used in Health Insurance Specialist jobs:
  • Post CPT codes and ICD-9 codes for every patient at check-out.
  • Respond to BCCPT referral forms within five working days of receipt.
  • Gather information on prior authorizations, benefit maximum, copays, coinsurance, cpt/hcpcs and j-codes for specific coverage.

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28. State Plan

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Here's how State Plan is used in Health Insurance Specialist jobs:
  • Drive processing of all State Plan Amendments (SPA) submitted by State of Kentucky for approval or denial.
  • Research current State Plan and requested changes to ensure requests are in compliance with Federal regulations.
  • Review State Plan Amendments for CHIP and provide technical assistance and program oversight of the program.
  • Perform detailed analysis of State Plan Amendments.

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29. Stakeholders

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Here's how Stakeholders is used in Health Insurance Specialist jobs:
  • Synthesized feedback from various industry groups, trade organizations, and internal/external stakeholders for consideration by senior management.
  • Provide customer services to beneficiary, providers by working collaboratively within the agency and external stakeholders.
  • Consulted with both internal and external stakeholders to provide information and assistance on contracting matters.
  • Established relationships with internal and external stakeholders to resolve problems with plan sponsors.
  • Facilitate meetings with contractors and other stakeholders.
  • Provide consultative and technical assistance to stakeholders.
  • Developed and maintain partnerships with a variety of key internal and external stakeholders to facilitate program goals or resolve common problems.
  • Provide consultative and technical assistance to stakeholders, contractors, congressional staff, and other internal and external contacts.
  • Served as liaison between ZPIC and law enforcement stakeholders and CMS stakeholders such as General Council and Inspector General.
  • Ensured the state and their stakeholders met the requirements outlined in the final federal transparency rule.
  • Build, strengthen and maintain collaborative relationships with internal and external clients, partners and stakeholders.
  • Serve as Subject Matter Expert and share AIM information with both internal and external stakeholders.
  • Developed and implemented communication strategy to ensure affected stakeholders, primarily CMCS Groups and Divisions approved project deliverables timely.
  • Collaborate with inter- and intra- agency partners, government contractors, and external stakeholders to improve the functioning of the Exchanges.
  • Facilitate SCRUMs and IT specific team meetings with projects' developers and other IT stakeholders; 5.

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30. Policy Issues

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Here's how Policy Issues is used in Health Insurance Specialist jobs:
  • Lead and conduct analysis of policy issues and topics related to individuals eligible for both Medicare and Medicaid.
  • Evaluated the impact of current and potential legislation on Part B ASP drug payment policy issues.
  • Conducted analyses of policy issues related to Medicare Parts C&D fraud.
  • Reviewed legislation affecting FQHCs/RHCs, identified and examined policy issues, and developed policy statements.

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31. Technical Support

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32. HMO

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Here's how HMO is used in Health Insurance Specialist jobs:
  • Performed underpayment reviews for Medicare, HMO's, and Commercial payers.
  • Worked with Medicare, Medicaid, HMO and PPO insurance programs.
  • Used HMO knowledge to assist on recommending health plan.
  • Licensed in Life, Accident, Health and HMO.

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33. Business Requirements

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Here's how Business Requirements is used in Health Insurance Specialist jobs:
  • Conduct review of enrollment related business requirements and Marketplace enrollment policies.
  • Design innovative solutions to meet client's business requirements.

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34. Issue Paper

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Here's how Issue Paper is used in Health Insurance Specialist jobs:
  • Prepare a variety of written products, including briefing documents, contractor performance evaluations, reports, and issue papers.
  • Prepare a variety of written products, proposals, reports, and issue papers.
  • Drafted correspondence, issue papers, and decision letters.

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35. Chcs

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Here's how Chcs is used in Health Insurance Specialist jobs:
  • Entered and updated insurance data in specialized military treatment facility software CHCS (Composite Health Care System).
  • Utilized CHCS to input, edit, and verify patient data, demographics and insurance information.
  • Worked with systems such as CHCS, DEERS, ALTA and TPOCS on a daily bases.
  • Utilize CHCS, ALHTA, and TPOCS computer based programs.

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36. Medical Benefits

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Here's how Medical Benefits is used in Health Insurance Specialist jobs:
  • Assist patients in obtaining and understanding medical benefits.
  • Verified Pharmacy and Medical benefits.
  • Assisted patients with medical benefits such as surgical clearances and exam translations.
  • Answer questions for client in regards to Medical Benefits * Process transactions * Provide an excellent customer experience

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37. Medical Billing

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Here's how Medical Billing is used in Health Insurance Specialist jobs:
  • Screened and reviewed third-party liability referrals for current and past Medicaid eligible clients for medical billing purposes.
  • Instructed students in the field of Health Insurance / Medical Billing.
  • Assist with medical billing, collection issues and clinical staff.

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1 Medical Billing Jobs

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38. Counsel

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low Demand
Here's how Counsel is used in Health Insurance Specialist jobs:
  • Provided strategic counsel to system developers to streamline processes and increase productivity.
  • Researched clients' insurance benefits/coverage and advised mental health counselors accordingly.
  • Counseled Medicare beneficiaries on Managed Care Plans.
  • Counseled Medicare beneficiaries on Medicare.
  • Counseled employees on benefits (Health Insurance, Life Insurance, Dental, Long Term Care, etc.)
  • Served as Medicare subject matter expert and provided counseling to over 4,000 Medicare clients in one-on-on meetings.
  • Developed dashboard to provide an overall view of the cost of counseling services vs. revenue received.
  • Answer incoming calls from congressional staff, beneficiaries, SHIP counselors, and providers.
  • Partnered with legal counsel on possible litigation cases.
  • Covered California and HealthCare.gov certified enrollment counselor.
  • reported to Director - responsible for the timely and accurate processing of all counseling insurance claims.

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39. Policy Changes

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Here's how Policy Changes is used in Health Insurance Specialist jobs:
  • Translated Medicare law, regulations, and policy changes to Medicare contractors.
  • Provided assistance to customers with all claims and policy changes and maintenance.
  • Handled policy changes, reconciled billing and account discrepancies.

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40. Special Projects

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Here's how Special Projects is used in Health Insurance Specialist jobs:
  • Worked special projects as assigned by manager
  • Work on special projects when needed to meet company's goal and objective.
  • Assist with department special projects and requests.

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41. Company Policies

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Here's how Company Policies is used in Health Insurance Specialist jobs:
  • Coordinated and performed Audits/Reviews to prospectively test compliance with established laws, regulations, company policies, and agency guidelines.
  • Complied with Federal DoD guidelines and state laws and policies, as well as company policies and procedures.

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42. General Public

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Here's how General Public is used in Health Insurance Specialist jobs:
  • Expand knowledge about Social Security among both claimants and the general public by disseminating easily understood information in multiple languages.

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43. Staff Members

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Here's how Staff Members is used in Health Insurance Specialist jobs:
  • Train new staff members on the TPC program and also on completing the paper form and electronic form E2569.
  • Improved the overall efficiency of customer service operation by assisting in the training of new staff members.
  • Work with other Human Services/Area Agency staff members in assisting clients with special Medicare/Medicaid needs.

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44. OHI

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Here's how OHI is used in Health Insurance Specialist jobs:
  • Maintain daily management system on the amount of OHI forms collected within the facility.
  • Verify patients' Other Health Insurance (OHI) via phone and websites.
  • Train all new employees on the OHI policies and procedures.
  • Maintain OHI coverage plans assigned.
  • Input OHI from E-2569 into CHCS PII computer data base after verification.

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45. Contractor Performance

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46. EOB

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low Demand
Here's how EOB is used in Health Insurance Specialist jobs:
  • Review and process the explanation of benefits (EOB) make corrections that need and resend for re-billing.
  • Handled billing, reviewed and processed Explanations of Benefits (EOBs) from all Insurance carriers for over 350 individual practitioners.
  • Provided updated knowledge of explaination of benefits (EOB's) to members as requested.
  • Work Medicare remittance denials and analyze patient accounts and review EOB'S work rejections and perform proper reimbursement analysis

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47. Patient Care

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48. Training Programs

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49. Social Security

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Here's how Social Security is used in Health Insurance Specialist jobs:
  • Referenced social security number discrepancies in EMPI.

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50. Small Business

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low Demand
Here's how Small Business is used in Health Insurance Specialist jobs:
  • Educate and support small business owners and their employee to obtain health insurance and federal tax credit for their company.
  • Provide sole support to the agency Broker in serving over 200 small businesses in Central New York.
  • Serve as subject matter expert to resolve complex inquires and escalations from small business employers and employees.
  • Assist individuals and small businesses secure insurance solutions for the future to establish and promote wealth.

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Health Insurance Specialist Jobs

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20 Most Common Skills For A Health Insurance Specialist

Insurance Companies

22.5%

Health Insurance Plans

15.9%

Insurance Policies

7.7%

Medicaid

7.6%

Customer Service

7.0%

Technical Assistance

6.8%

CMS

6.6%

Providers

3.9%

Medicare

3.2%

Oversight

2.6%

Officer Representative

2.2%

Phone Calls

2.1%

Data Entry

1.9%

Hipaa

1.9%

Marketplace

1.7%

ACA

1.5%

Medical Records

1.4%

Hippa

1.2%

State Regulations

1.2%

Life Insurance

1.0%
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Typical Skill-Sets Required For A Health Insurance Specialist

Rank Skill
1 Insurance Companies 19.0%
2 Health Insurance Plans 13.4%
3 Insurance Policies 6.5%
4 Medicaid 6.4%
5 Customer Service 5.9%
6 Technical Assistance 5.7%
7 CMS 5.6%
8 Providers 3.3%
9 Medicare 2.7%
10 Oversight 2.2%
11 Officer Representative 1.9%
12 Phone Calls 1.8%
13 Data Entry 1.6%
14 Hipaa 1.6%
15 Marketplace 1.4%
16 ACA 1.3%
17 Medical Records 1.2%
18 Hippa 1.0%
19 State Regulations 1.0%
20 Life Insurance 0.9%
21 Regional Office 0.8%
22 New Clients 0.7%
23 COR 0.7%
24 Outbound Calls 0.7%
25 HHS 0.7%
26 Icd-9 0.7%
27 CPT 0.7%
28 State Plan 0.6%
29 Stakeholders 0.6%
30 Policy Issues 0.6%
31 Technical Support 0.6%
32 HMO 0.5%
33 Business Requirements 0.5%
34 Issue Paper 0.5%
35 Chcs 0.5%
36 Medical Benefits 0.5%
37 Medical Billing 0.5%
38 Counsel 0.5%
39 Policy Changes 0.5%
40 Special Projects 0.5%
41 Company Policies 0.5%
42 General Public 0.5%
43 Staff Members 0.4%
44 OHI 0.4%
45 Contractor Performance 0.4%
46 EOB 0.4%
47 Patient Care 0.4%
48 Training Programs 0.4%
49 Social Security 0.4%
50 Small Business 0.3%
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12,868 Health Insurance Specialist Jobs

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