INSURANCE SPEC

Overview

To process accurate and timely billings to insurance carriers and to ensure correct payment is received from them in a timely fashion.

Position Reports To: Business Office Manager

Responsibilities

1. Works assigned Workqueues in Epic and HealthCareIP systems on a daily basis.
2. Processes secondary or tertiary claims as needed by accurately attaching the appropriate primary EOB prior to submission.
3. Accurately codes insurance information on coverage records in Revenue Cycle system within 24 hours of receipt. When necessary, verifies information via various electronic means.
4. Maintains workqueues generated by electronic submission of claims, correcting errors and reprocessing claims as needed.
5. Via workqueues and receipt of correspondence from insurance carriers, provides follow-up of unpaid (or incorrectly paid) claims as dictated by department policy. Submits corrected claims as needed and processes appeals for incorrectly denied claims. (Processes write-offs as needed and as dictated by department policy.).
6. When available, processes on-line adjustments to insurance claims.
7. Complies with audit requests by insurance carriers in a timely fashion.
8. When necessary, reviews medical records and resubmits claims with appropriate documentation to expedite claims processing (adhering to confidentiality requirements).
9. Accurately processes corrections on accounts and/or active claims by error correcting or voiding transactions as indicated in department policy. Posts appropriate adjustments as needed.
10. Appropriately documents all patient accounts with each action taken and each contact made.
11. Thoroughly researches credit balances and processes insurance refunds or adjustments as needed.
12. Responsible to keep up-to-date with current insurance billing requirements and changes by reading payer newsletters, reviewing websites and other publications.
13. Participates in payer meetings, developing relations with payer representatives and assisting with troubleshooting and problem-solving processes.
14. Actively participates in departmental and/or organizational process improvement initiatives.
15. Assists in other areas of the department (i.e., payments or coding) as needed.
16. Assists providers and staff in other departments with insurance and billing inquiries in a friendly and professional manner while on the phone or corresponding through email.
17. Assists in maintaining a neat and professional work place.
18. Works on special projects related to A/R clean up as requested by Manager.
19. Other duties as assigned.

Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.

Qualifications

Required:

• High school diploma or GED.
• Proficient in the performance of basic math functions.
• Possesses basic computer (e.g., spreadsheets, word processing) skills.
• Must be a team player.
• Maintains a positive, resourceful attitude toward achieving overall department and clinic goals.

Desired:

• Knowledge of ICD-10, CPT coding, medical terminology, and medical insurance billing.