Insurance Claim Specialist

Southern Ohio Medical Center•Portsmouth, OH

19d

About The Position

The Insurance Claim Specialist works under the supervision of the Assistant Manager of Claims Management and Lead Insurance Claim Specialists. The role analyzes, processes, submits, and follows up on inpatient and outpatient medical claims. It also requires safeguarding the organization’s public relations and the confidentiality of its records through consistent professional conduct.

Requirements

High school diploma or successful completion of an equivalent high school examination.
Three to six months of related work experience in medical billing is preferred.

Nice To Haves

Three to six months of related work experience in medical billing.

Responsibilities

Review claims for complete and accurate information.
Contact SOMC departments, physician offices, and insurance companies to obtain information needed to file complete, accurate, and timely claims.
Process, edit, and submit claims for the organization.
Follow up on Commercial, Worker's Compensation, VA, and governmental claims by phone, insurance company websites, or other available online resources.
Assist patients or guarantors by phone with questions about unpaid claims.
Obtain information from patients or guarantors needed to submit claims for payment, including claim forms and Medicare Secondary Payer questionnaires.
Process administrative appeals, reinstatements, and insurance claim rejections.
Complete account follow-up daily, maintain established goals, and notify the Lead Specialist when issues prevent achievement of those goals.
Analyze daily correspondence, including denials and underpayments, and resolve issues appropriately.
Follow HIPAA regulations by verifying caller authorization before disclosing account information.
Identify billing and coding issues on individual claims and notify medical billers for correction.
Use online systems to determine patient eligibility and coverage and review claim status.
Perform other duties as assigned.

Benefits

Competitive pay with quarterly market analysis.
Performance-based annual increase and bonus eligibility.
Up to 4% employer contributions to retirement plans, including a 403(b) and Cash Balance Pension.
Medical, dental, and vision coverage.
Medical and dependent care flexible spending accounts.
Earned Wage Access.
Paid Time Off bank with three annual sick days.
Life insurance and disability coverage.
Tuition and certification assistance.
Discounted or free gym membership through Club LC.
Employee discount and payroll deduction programs.
Other benefit offerings.