Insurance Reviewer II
About The Position
The Insurance Reviewer II completes assigned tasks to secure payment from third-party payors and reports observed trends and issues to management. The position handles insurance-related calls and messages, reviews and processes insurance vouchers and claims, rebills unpaid charges, processes adjustments and secondary billing, and responds to audits and information requests. The role also analyzes claim edits and denials, investigates insurance work files and reports, and provides customer service while maintaining confidentiality and complying with applicable clinic policies and training requirements.
Requirements
- High school diploma or GED.
- Previous experience in a medical billing office.
- Computer, typing, and calculator skills.
- Ability to work independently or as part of a team.
- Confidentiality is required.
Nice To Haves
- Working knowledge of medical terminology.
- Working knowledge of CPT and ICD-9 coding.
Responsibilities
- Handle calls and messages related to the designated insurance area.
- Update registration screens when requested by patients or as necessary.
- Review and process designated insurance vouchers, rebill unpaid charges, and process adjustments using websites or telephone as needed.
- Process secondary billing as requested by patients or required by procedure.
- Distribute incoming insurance mail and respond to audits, inquiries, and requests for additional information.
- Process corrections and adjustments to correct patient invoices.
- Conduct designated insurance reviews to obtain additional claim payments using websites or telephone as needed.
- Analyze and process front-end system edits to support accurate physician productivity and claim billing.
- Analyze and process back-end system edits to support accurate registration and claim billing.
- Analyze and process claims denied through the clearinghouse.
- Investigate and process claims in insurance work files and/or insurance reports.
- Report all incidents to the immediate Supervisor or Manager.
- Assist with special projects and assignments as directed.
- Attend relevant in-services and training.
- Perform other assigned job duties.
- Maintain confidentiality.
- Comply with Springfield Clinic incident reporting policies and procedures.
- Adhere to OSHA and Springfield Clinic training and accomplishment requirements, as required by policy.
- Provide excellent customer service and adhere to the SC Way customer service philosophy.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
