Insurance Reimbursement Specialist II

Insurance Reimbursement Specialist II

Job Code : 28560

Position Summary

Responsible for the timely follow-up of insurance and government payer balances on hospital and professional accounts receivable (HB and PB), to ensure prompt payment, prevent payment delays and resolve claims inquiries, rejections and denials from third party payers.

Performs duties to promote reduction of A / R Days, prevent bad debt, and maximize net revenue and cash flow from patient billing operations.

Responsibilities

• Analyze A / R reports to perform collection follow-up on outstanding receivables, and determine the appropriate prioritization of follow-up action required
• Work with payer websites, electronic tools, phone and other mechanisms, to ensure timely and full payment from third party payers.

Reviews remittance advice for no pays or short pays to verify proper reimbursement, conduct follow-up with payers, or to make adjustments as necessary

• Identifies coding and billing errors from the EOB and works with all partner departments to correct errors and re-bill in a timely manner
• Appeals improperly adjudicated claims so they are promptly corrected and paid
• Supports Revenue Cycle by providing A / R, denials and appeals information, in required reporting formats
• Supports Customer Service, Financial Counseling, and Patient Advocacy in response to patient billing inquiries or complaints
• Provide support to registration, customer service, billing and accounts receivable collections functions, as appropriate
• Interacts with patients, clinicians, insurers, and billing management to ensure timely submission of appeals and timely collection of accounts
• Perform duties in compliance with state and federal regulatory requirements, and Kootenai Health policies and procedures governing Revenue Cycle compliant processes
• Performs other related duties as assigned
• Familiar with standard concepts, practices, and procedures within the field
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• High school diploma preferred. Billing Specialist Certification or Associates degree preferred
• 5 years’ professional experience working in a hospital or medical office with current commercial and government payer types, and strong understanding of payment methodologies
• At least 2 years’ hands-on experience processing 1500 or UB billing forms
• Demonstrated ability to navigate through commercial payer and government agency websites, to research and understand billing requirements and instruction, and regulatory guidelines
• Demonstrated ability working in hospital and professional EMR billing, and supporting eligibility systems, and ability to read and understand a patient medical record sufficient to conduct HB or PB claims-related research
• Medical terminology understanding required
• Excellent communication, organizational and analytical skills required
• Ability to work equally well in a team environment, and independently with minimum supervision
• Knowledge and demonstrated competence working with Microsoft Office software, to include Excel, Word, and e-mail programs to include reporting

Working Conditions

• Must be able to lift and move up to 10 lbs
• Must be able to reach arms above or below shoulder height
• Must be able to maintain a sitting position
• Typical equipment used in an office job
• Repetitive movements
• Remote eligible

About Kootenai Health

Kootenai Health is a highly esteemed health care organization, serving patients throughout northern Idaho and the Inland Northwest.

We pride ourselves on our outstanding reputation as both an employer and a health care provider. We have been recognized with many accolades and distinctions including being recognized as a Gallup Great Workplace, No.

1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence.

As your next employer, we are excited to offer you :

100% employer-paid health insurance premiums for full-time employees. Part-time employees pay only a small portion a month for medical, dental, and vision coverage.

Benefits start 1st of the month following 30 days of employment

• A tuition assistance program available after 90 days. If you want to further your education, we'll help you pay for it
• Kootenai Health retirement plan
• An award-winning and incentive-driven wellness program. Including a MyHealth corporate team, onsite financial seminars and coaching
• Employees receive discounts at The Wellness Bar, PEAK Fitness, various cell phone carriers, and more
• Robust and interactive employee bonus program,
• And much more

If you strive to be an integral part of a high-quality healthcare system like Kootenai Health, we want to meet you!

Apply today! Please reach out to Lindsay Buchanan [email protected] with any questions.

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex.

Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

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