Insurance Specialist II

Eastern Nephrology Associates•Greenville, NC

22h•$18 - $21•Onsite

About The Position

The Insurance Specialist II reviews Explanation of Benefits (EOBs), incoming reimbursements received by electronic deposit or paper check, and payor remittance advice to ensure payments are accurately distributed and posted to accounts. The role audits billing documents for completeness and accuracy, maintains accounts, and follows up on denials and outstanding claims. This is an on-site, patient-facing role requiring in-office presence for real-time collaboration with providers, interaction with patients and caregivers, and secure handling of health information in compliance with HIPAA. Work is normally performed in a typical interior office environment with moderate noise and low risk of exposure to blood-borne pathogens and other potentially infectious materials. The schedule is Monday through Friday, 8 a.m. to 5 p.m., with slight modifications possible with manager approval. Overtime may be required as needed to accomplish the organization's mission. The position has no supervisory responsibilities.

Requirements

Proficiency in processing medical insurance claims.
Knowledge of medical billing and collection practices and an above-average understanding of debits and credits.
Knowledge of basic medical coding and third-party operating procedures and practices.
Three years of related experience and an associate degree, or an equivalent combination, with at least two years of medical insurance claims experience.
Proficiency in Microsoft Office, including Word, Outlook, and Excel, and in word processing and spreadsheets.
Knowledge of applicable EHR and practice management systems, including Allscripts PM, Clinical Module Medical Records, and Document Manager.
Familiarity with completing CMS 1500 claim forms.
Ability to pass criminal background, OIG exclusion, and drug screenings.
Reliable transportation.
Excellent records maintenance and attention to detail.
Strong oral and written communication skills.
Ability to work proactively and independently, make decisions, accept direction, cooperate with others, and perform repetitive tasks.
Strong interpersonal skills for working with diverse constituencies.
Understanding of healthcare billing procedures, documentation, standards, and third-party payor billing and payment cycles.
Ability to make evaluative judgments, multitask, concentrate on details, and organize resources.
Knowledge of ethical standards for following up on overdue accounts and of credit and collection principles, process regulations, and standards.
Ability to analyze medical records and identify billable services.
Ability to meet the stated physical demands, including frequent lifting or moving of up to 10 pounds, repetitive data entry, regular standing, talking, and hearing, occasional sitting, stooping, kneeling, or crouching, full body motion, manual dexterity, and eye-hand coordination.

Nice To Haves

Ability to read and interpret the most current CPT and ICD coding.

Responsibilities

Process third-party payor EOBs and annotate accounts with relevant information.
Identify and correct errors in patient accounts, including overpayments, and consult the Billing and Reimbursement Supervisor regarding delinquent accounts.
Submit adjustments for overpayments and post recoupments shown on remittance advice.
Research and accurately distribute incoming payments and remittance advice.
Manage third-party payor follow-up work queues to support timely reimbursement, checking every 45 days.
Address issues related to third-party payor rejections.
Verify benefits by communicating with patients, guarantors, and insurance companies.
Maintain and organize master document files to verify and back up entered data.
Review third-party payor bulletins, guidelines, and requirements and keep current with changes.
Follow safety policies, participate in safety training, comply with billing requirements, and maintain confidentiality in accordance with HIPAA guidelines.