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Description Insurance Specialist – on site General Description Of Position - Responsible for processing and filing insurance claims, assisting patients with billing questions, and answering the business office telephone. Correcting and following up on denied claims for all insurances, reviewing denials to determine the underlying reason, and researching solutions. This position requires submitting appeals and correcting claims as needed to maximize reimbursement.
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 ensure 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 regard 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 strict 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.
- Help train new front desk employees on insurance and referrals.
- Perform any other related duties as required or assigned.
Requirements QUALIFICATIONS To perform this job successfully, an individual must be able to perform all essential duties satisfactorily. The following requirements represent the knowledge, skills, and abilities necessary for the role.
Education And Experience High School Education or GED. Minimum of 3 years clinic level billing, appeals, reconsideration and denial claim 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.
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