Insurance Specialists perform many accounting, customer service, and organizational tasks to promote the financial health of their organization.
Principal Duties and Responsibilities:
- Prepares and submits clean claims to third-party payers either electronically or by paper.
- Maintains relationship with clearinghouse, including appropriate follow-up with support issues.
- Data entry on patient charges and refunds.
- Coordinate the process of patient eligibility through various third-party sources.
- Post and review payments received to appropriate patient’s account.
- Monitor and collect accounts receivables. Report delinquent accounts to the Billing Manager.
- Responsible for keeping in contact with the responsible parties involved as to payments due and the status of their accounts.
- Manage monthly statement process, including reviewing statements before mailing and field any patient inquiries the front desk staff needs to escalate.
- Work with front desk staff, ensure appropriate collection of co-pay, spend down, and self-pay fees.
- Handles patient inquiries and answers questions from clerical staff and insurance companies.
- Identifies and resolves patient billing problems.
- Denial and insurance follow-up management.
- Issues adjusted, corrected, and/or rebilled claims to third-party payers.
- Assure coding is compliant and up to date.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Other duties and projects as assigned by management.
- Relevant experience as insurance specialist or similar position.
- Proficient in Microsoft applications and data entry.
- Strong understanding of relevant laws and best practices.
- Strong comfortability in an office environment.
- Ability to perform mathematical calculations quickly and accurately.
- Strong work ethic and emphasis on attention to detail. Works with integrity and ethically.
- Excellent communication and interpersonal skills.
- Highly organized and capable of effectively prioritizing and multi-tasking.
- Understanding of specific policies such as HIPAA regulations.
- Ability to maintain a high level of confidentiality.
Physical Demands/Working Conditions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Working Conditions: Office setting with a forty-hour (+) workweek. Work includes pressure generated by deadlines, peak workload periods, and frequent interruptions.
- Physical Demands: Work includes extended periods of talking or hearing, use of vision, typing on a computer, performing repetitive motions, manual dexterity/motor skills. Frequent sitting and use of standard office equipment.
Weekly Hours: 40
This position is eligible for all benefits based on established organizational policies