Insurance Specialist I

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 and works with coworkers to resolve payment and billing errors.
• Maintains and updates delinquent accounts status, recommends accounts for collection or write-off, and verifies necessary referral and authorization documentation.
• Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
• Answers patient payment, billing, and insurance questions and resolves complaints, and may refer patients to a Patient Benefits Representative 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.
• Performs other duties as requested or assigned.

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.

Benefits

• Health, dental, and vision plans.
• Wellness program.
• Health savings account - Flexible spending accounts.
• 401(k) retirement plan.
• Life insurance.
• Short-term disability insurance.
• Long-term disability insurance.
• Employee Assistance Program (EAP).
• Paid Time Off (PTO) and holiday pay.
• Tuition discounts with numerous universities.