Insurance Specialist

Responsibilities

• Maintains delinquent accounts and performs collection duties.
• Reviews reports, identifies denied claims, researches and resolves issues, and performs detailed reconciliations of accounts.
• Resubmits claims to payers.
• Works with co-workers to resolve payment and billing errors.
• Maintains delinquent accounts status and recommends accounts for collection or write-off.
• Verifies existing patients have necessary referral and/or authorization documentation before examination date.
• Contacts and follows up with patients’ physicians for missing or incomplete documentation.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, and updates information in systems.
• Documents conversations with patients.
• Answers patient payment, billing, and insurance questions and resolves complaints.
• Refers patients to Patient Benefits Representatives to set up payment plans.
• Contacts third-party payors to resolve payor issues, expedite claim processing, and maximize medical claim reimbursement.
• Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records.

Qualifications

• High school diploma or equivalent required.
• Minimum four (4) years combined medical billing and payment experience required.
• Demonstrate knowledge of medical coding, preferably oncology coding.
• Demonstrate knowledge of state, federal, and third party claims processing.
• Demonstrate knowledge of state & federal collections guidelines.
• Must successfully complete required e-learning courses within 90 days of occupying position.