INSURANCE SPECIALIST

Description :

GENERAL DESCRIPTION OF POSITION

Responsible for processing and filing of insurance claims, assisting patients with billing questions, answering business office telephones, correcting and following up with denied claims for all insurances.

This position requires someone to review all denials that come through and research to find out the reason of denial. This position requires someone to send in appeals and correct claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assists in processing all insurance claims.
• Pull EOB's (explanation of benefits).
• Evaluate Patient Financial Status.
• Review and verify insurance claims. File paper and electronic appeals on denied claims.
• Follow up with insurance companies and insure claims are paid. Work outstanding insurance claims and follow up with insurance companies for payment.
• Work from EOB's (Including Medicare) and correct any denied claims in a timely manner. Work miscellaneous claim error reports given by supervisor.
• Assist patients via phone or in person, in regards to insurance questions.
• Answers inquiries and correspondence from patients and insurance companies and identify and resolve patient bill complaints.
• Review medical records to clarify information and answer questions.
• Resubmit insurance claims that have not yet received a response.
• Participate in educational activities.
• Maintain strictest confidentiality.
• Work zero pay report to identify posting errors by software company.
• Manually key claims into the Medicaid system and oversee all providers diamond plan balances to ensure they don't go over the limit.
• Download all Medicaid RA's intor Laserfiche, help with getting retro authorizations for Medicaid patients and file Medicaid Extension of Benefits.
• Help train new front desk employees on insurance and referrals.
• Perform any other related duties as required or assigned.

Requirements : QUALIFICATIONS

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty mentioned satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.

EDUCATION AND EXPERIENCE

High School Education or GED. Minimum of 3 years clinic level billing, appeals, reconsideration and denial claims processing.

Medicare and Medicaid claims experience preferred. Knowledge of basic insurance information, medical billing / collection practices, basic medical coding and third-party operating procedures and practices, basic medical terminology and knowledge of insurance industry a plus.

Previous clinic or medical office experience highly preferred.

Knowledge :

• Knowledge of basic insurance information.
• Knowledge of medical billing / collection practices.
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Knowledge of basic medical terminology.
• Knowledge of insurance industry.

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