Specialist, Insurance Revenue Cycle

About SHERLOQ Solutions

Established in 1916, SHERLOQ began as a member-owned cooperative in Tampa, Florida. The founding mission was to facilitate the sharing of credit information, promote the equitable principles in trade and give back to the community. Over 100 years later, SHERLOQ continues as a vibrant company serving hospitals, healthcare systems, physician practices and utilities nationwide.

Position Summary

This position will require the employee to effectively communicate between healthcare providers and health insurance payers to expedite claim resolution.

Essential Duties and Responsibilities

• Resolve healthcare claims through verbal or online inquiries to health insurance payers.
• Effectively navigate and utilize healthcare provider systems, billing platforms, and payer websites.
• Verify patient, insurance, billing and claim submission information for accuracy.
• Eligibility inquiries and coordination of benefits research including reaching out to the patient when necessary.
• Analyze payer denials and appropriately respond to secure claim reimbursement.
• Provide information to the Billing & Appeals Specialists on claims that require written appeals.
• Track trends in payer underpayments, coding issues and denials and report to leadership for escalation.
• Recognize basic coding denials and request appropriate action for correction or dispute.
• Check insurance payments for accuracy and compliance with contract discount.
• Research missing payments and secure documents needed for posting.
• Demonstrated ability to remain patient, professional & effective in high pressure and high-volume environments.
• Meet or exceed daily, weekly and monthly performance goals, deadlines and objectives.
• Perform other related duties as assigned.

Abilities

• Excellent verbal and written communication skills.
• Excellent interpersonal and negotiation skills.
• Organized with attention to detail.
• Ability to read and interpret insurance explanation of benefits.
• Ability to problem solve and think critically to identify trends.
• Demonstrated proficiency in Microsoft 365 (Teams, Outlook, OneDrive, SharePoint) within a cloud-based, collaborative environment.

Experience and Education

• High school graduate or equivalent required.
• Three (3) years of healthcare industry experience required.
• One (1) year of healthcare claims billing, insurance collections, coding, and/or denials management required.
• Specific healthcare payer experience may be required (e.g., Medicare or state-specific payers).
• Obtain HFMA CRCR or AAHAM CRCS accreditation within two years of employment and maintain certification in good standing.

Pay Range: $18+ per hour

Schedule: Monday- Friday 8am-5pm

We value our employees and offer a comprehensive benefits package including medical insurance, 401(k), paid time off, paid holidays, tuition reimbursement, and additional supplemental benefits.SHERLOQ is an Equal Opportunity Employer and considers all qualified applicants without regard to race, color, religion, sex, national origin, disability, or veteran status.

If you feel this is the right opportunity for you, we encourage you to apply. We look forward to meeting you!