Insurance Claims Account Specialist

Insurance Claims Specialist

Position Summary : The Insurance Claims Specialist is responsible for posting insurance payments from EOBs, following up and correcting errors on EOBs or submitted claims, and working denials. Work Schedule : This position is on-site with a schedule of Monday - Friday 7 : 30 am - 4 : 00 pm Essential Functions :

• Post insurance payments timely and balance to each EOB to ensure all lines are posted accurately.
• Manage electronically posted EOBs, research flagged lines and resolve issues that prevented automatic posting utilizing the company's billing system and other internal / external systems to research claim details.
• Work denied claims included on EOBs, which involves using various external tools (Availity, UHCLink, UMR) and internal resources (billing system, Westside app) to research claim status.
• Appeal denials as necessary by submitting appropriate documentation to insurance carriers and following up regularly.
• Review accounts receivable balances for outstanding insurance amounts due and follow up with payers to arrange payments.
• Ensure patient account records are up-to-date and accurate.
• Manage insurance company correspondence, which may include medical records requests, denials of coverage, refund requests, etc.
• Set the tone of quality and effort expected of the team.
• Adhere to all practice policies related to HIPAA.

Qualifications

Required Education, Experience and Credentials :

Knowledge, Skills and Abilities :

Personal Attributes :

Work Environment & Physical Demands :

Travel Requirements :

This is a full-time position. Full-time employees are eligible for a comprehensive range of benefits, including Medical, Dental, Vision, and Life Insurance; a 401(k) retirement plan with company match; Paid Time Off; Sick Time; and a robust Employee Assistance Program.