Insurance Specialist I - Corporate Patient AR Management - Full Time

Position Summary

Responsible for non-complex electronic and paper claim submissions to insurance payers. Coordinates required information for filing secondary and tertiary claims reviews and analyzes claims for accuracy. Works on denied claims by following correct coding and payer guidelines resulting in appeal or charge correction. Teams with Insurance Billing Specialist II and Denial Resolution staff to work projects, request guidance on more complex billing issues and cross-train for other payers and tasks. Responds to a variety of questions from insurance companies, government agencies and all Guthrie Medical Group offices. Partners with CRC and other Guthrie departments to field billing inquiries. Answers all correspondence from insurance carriers including requests for supportive documentation.

About the Role

Works pre-AR edits, paper claims, reports and work queues as assigned to ensure accurate and timely claim submission to individual payers. Reports possible payer or submission issues.

Responsibilities

• Works closely with a Denial Resolution Specialist or Billing Specialist II mentor to cross train on various payers and tasks to expand insurance billing knowledge and skills.
• Follows up on rejected and/or non-responded claims as assigned. Utilizes internal rejection protocols, coding knowledge, reimbursement policies, payer guidelines and other sources in order to research rejections to secure appropriate payment.
• Provides back-up to Central Charge Entry and Cash Applications. Manually enters charges, posts and distributes insurance and patient payments.
• Promptly reports payer, system or billing issues.
• Utilizes Epic system functions accurately to perform assigned tasks. Ex: charge corrections, invoice inquiry, billing edits, insurance eligibility.
• Exports and prepares spreadsheets, manipulating data fields for project work.
• Identifies and provides appropriate follow-up for claims that require correction or appeal.
• Provides timely resolution of credit balance as identified and/or assigned. Documents support on request forms and performs adjustments within policy guidelines.

Requirements

• Strong organizational and customer service skills a must.
• Experience with office software such as Word and Excel required.
• Previous experience performing in a high volume and fast-paced environment.

Qualifications

• High school diploma required; CPC, CCA, RHIA, RHIT certification in medical billing and coding or Associates degree preferred.

Skills

• Excellent customer service skills for both internal and external customers.
• Maintains strict confidentiality related to patient health information in accordance with HIPAA regulations.
• Assists with and completes projects and other duties as assigned.

Benefits

Not specified.

Pay

Not specified.

Schedule

Not specified.