[Hiring] Insurance Specialist @Seven Counties Services

Role Description

• Completes information on insurance forms.
• Completes 1500 HCFA insurance for specifications required by insurance companies to allow for timely payment.
• Maintains a workable knowledge regarding specifications in billing Medicare, Medicaid, Tricare, and Commercial, monitoring those accounts to meet specifications.
• Monitors 1500 for demographic, CPT, and charge accuracy.
• Monitors current fee schedule and recommends changes as necessary, in compliance with state and federal law.
• Assists insurance companies inquiring about accounts relative to insurance benefits deposition.
• Demonstrates knowledge of the personal computer and applicable keystrokes in the electronic transmission of claims, including the correction of claims with minimal interruption.
• Maintains a workable knowledge of the physician billing system.
• Follows up on unpaid claims for both insurance and patients via phone, fax, or mail, knowing when to become assertive.
• Identifies overpayments on patient accounts and initiates refund and adjustment process in accordance with internal controls.
• Answers phone and assists customers promptly and courteously who are geriatric or emancipated minors.
• Assists physician offices promptly and courteously.
• Maintains a working knowledge of PCN, retrieving information as needed for daily work disposition.
• Maintains strict patient confidentiality.
• Performs special assignments as required.
• Able to demonstrate proper usage of office equipment.
• Researches line item EOBs for incorrect payment levels and works directly with insurance companies for assurance of benefits and correct reimbursement through oral and written communication.
• Monitors and maintains control for balancing purposes.
• Monitors appropriate codes using the ICD-9 and the CPT formats.
• Prints, reviews, and mails all insurance claims as needed on a regular basis.
• Responds to and/or directs all correspondence.
• Maintains direct line of communication with the providers and staff.
• Communicates with the AR Manager regarding problem areas.
• Maintains knowledge of Corporate Compliance issues pertaining to daily work.
• Performs other duties as assigned.

Qualifications

• High school graduate or equivalent required.
• Productive typing ability equivalent to 30 w.p.m. required.
• Considerable skill in interpersonal communications and the ability to work well with others as a team required.
• Ability to keep accurate financial records and perform mathematical tasks required.
• Knowledge of medical terminology, ICD-10, and CPT coding required.
• Knowledge of E/M procedural coding preferred.
• Computer knowledge required.
• Knowledge of Windows preferred.

Requirements

• Minimum of two years of experience in a medical billing environment working with insurance and patient claims processing required.

Physical Demands

• Position has no unusual demands.
• Typical office job, requiring lifting of 10 pounds maximum, with occasional lifting and carrying of medical records.
• Position may require walking or standing, stooping, or bending.
• Minor discomfort from continual use of video display terminal.

Time Type

• Full time