Health Insurance Operations Director directs and oversees health insurance operations programs in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility. Manages vendors assigned to each operation. Being a Health Insurance Operations Director resolves issues within each service area. Has deep knowledge of health insurance operations. Additionally, Health Insurance Operations Director typically requires a bachelor's degree of business administration or its equivalent. Typically reports to top management. The Health Insurance Operations Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Health Insurance Operations Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Insurance Specialist
Business Services Department
1.0 FTE, 80 Hours a Pay Period
Days, Hours between 7:30 am – 4 pm
Weekends: No
Holidays: No
Telecommute Available: Partial
Position Overview:
The Insurance Specialist is responsible for the back-end office processing of insurance claims for Winona Health Services. Responsible for processing claims including but not limited to answering inquiries from insurance companies and patients, rejections, denials, appeals and incorrect payments, follow-up of past due claims, monitor payment/adjustments from contracted insurance payments, and identifying credit/refunds on accounts to keep A/R days within goal range of 35 - 45 days. Responsible for back-end office processing of insurance claims in a designated section of the alphabet and/or payer split as determined by the Director/Supervisor. May also work with nursing home client billing for Medicare Part A billing requirements. Position is responsible for the back-end office processing of claims which may include one or more of the following; checking eligibility and resubmitting insurance claims through clearinghouse according to insurance, state and/or federal regulations.
Essential Duties & Responsibilities:
Essential Skills and Experience:
Internal Applicant Policy:
It is the policy of Winona Health to work with employees in an equitable fashion regarding promotions, transfers, and position reclassifications.
Any employee wishing to apply for another available position at Winona Health must submit an application for consideration through the internal application portal. Employees requesting to change positions should have successfully completed at least six (6) months in their current position. Employees currently in the formal disciplinary process may be required to meet with the Director of Human Resources to determine eligibility to request transfer. The employee’s past performance, experience, training and qualifications will be considered in transfer/hiring decisions. Consideration for transfer or promotion is not a guarantee of transfer or promotion. Employees may be given a chance to interview for a position when they meet the minimum position qualifications.
Disclaimer:
Winona Health is an equal opportunity employer. Winona Health does not refuse to hire, discharge, or discriminate against a person with respect to tenure, compensation, terms, upgrading, conditions, facilities, or privileges of employment because of race, color, creed, religion, sex, age, national origin, marital status, genetic information, status with regard to public assistance, membership in a local discrimination commission, sexual orientation, disability, veteran status, or any other prohibited basis of discrimination under applicable local, state, or federal law. Winona Health does not tolerate retaliation against any employee, patient/resident, physician, or other individuals pursuing concerns regarding Civil Rights issues. Winona Health adheres to ALL pertinent governmental policies and legislation including the Civil Rights Act of 1964, Title VII, as amended, and the Minnesota Human Rights Act.
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