Insurance Eligibility & Claims Scrubbing Specialist

Insurance Eligibility & Claims Scrubbing Specialist
Position Type: Full-Time, Remote
Schedule: U.S. Business Hours

MUST HAVE EXPERIENCE WITH PEDIATRIC BILLING AND REVENUE CYCLE

Position Overview
We are seeking an experienced Insurance Eligibility & Claims Scrubbing Specialist to support our busy pediatric medical location.

Primary Responsibilities
Insurance Eligibility & Benefits Verification

• Verify insurance eligibility for scheduled patients prior to their appointments.
• Confirm that insurance coverage is active for the date of service.
• Verify patient demographic and subscriber information against payer records.
• Verify eligibility through payer websites, clearinghouses, automated systems, or telephone calls when necessary.
• Identify Medicaid, CHIP, commercial insurance, and managed-care coverage as applicable.
• Confirm coordination of benefits when multiple insurance policies are listed.
• Identify insurance discrepancies before the patient's appointment.
• Document verification results clearly and consistently.
• Reverify coverage when necessary due to plan changes or payer requirements.

Claims Scrubbing & Pre-Submission Review
Review claims before submission to identify errors that could cause a claim to be rejected, denied, or delayed.
Responsibilities include:

• Review claims for completeness and accuracy before transmission to the clearinghouse or payer.
• Confirm patient demographic and insurance information matches the patient's eligibility information.
• Verify the correct payer and insurance plan are attached to the claim.
• Review claims for missing or incorrect:
• Review clearinghouse edits and claim-scrubber alerts.
• Correct administrative claim errors within the scope of assigned responsibilities.
• Route coding or clinical discrepancies to the appropriate biller, coder, or provider rather than making unsupported coding decisions.
• Identify duplicate claims or potentially duplicate services.
• Verify that required insurance information is present before claim submission.
• Review rejected claims and correct errors that can be resolved administratively.
• Resubmit corrected claims promptly.
• Help maintain a high clean-claim submission rate.

Pediatric-Specific Responsibilities
Because this position supports a pediatric location, the candidate should be comfortable working with insurance issues commonly encountered in pediatric care, including:

• Medicaid and CHIP eligibility
• Managed Medicaid plans
• PCP assignment requirements
• Well-child visits
• Sick visits
• Preventive-care benefits
• Immunization-related claims
• Newborn coverage and insurance enrollment issues
• Coverage under a parent or guardian
• Coordination of benefits involving multiple parents or policies
• Age-dependent insurance requirements
• Referral requirements for pediatric specialists

Experience with pediatric billing or insurance verification is strongly preferred.

Required Qualifications

• Previous experience working with a U.S.-based pediatric practice.
• Previous experience with U.S. medical insurance eligibility verification.
• Previous experience reviewing or scrubbing medical claims before submission.
• Working knowledge of commercial insurance, Medicare/Medicaid concepts, and managed-care plans.
• Experience using payer portals and clearinghouses.
• Familiarity with CPT, ICD-10, HCPCS, modifiers, and basic medical billing terminology.
• Ability to identify common claim errors and missing information.
• Strong attention to detail and data-entry accuracy.
• Strong written and spoken English.
• At least 2 years of medical billing, eligibility verification, or revenue-cycle experience.
• Experience with Medicaid and managed Medicaid plans.

How to Apply
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