Insurance Specialist II

Eastern Nephrology Associates•Greenville, NC

12d•Onsite

About The Position

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. 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 collaboration with providers, interaction with patients and caregivers, and secure handling of health data. Work is normally performed in an interior office with moderate noise and low risk of exposure to blood-borne pathogens and other potentially infectious materials. The regular schedule is Monday through Friday, 8 a.m. to 5 p.m.; slight schedule modifications may be made with manager approval. Overtime may be required as needed. Employees may be assigned other duties.

Requirements

Three years of related experience and an associate degree or equivalent combination, with at least two years of medical insurance claims experience.
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.
Proficiency with Microsoft Office, including Word, Outlook, and Excel, and with 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.
Pass a criminal background check, OIG exclusion screening, and drug screening.
Reliable transportation.
Excellent records maintenance and attention to detail.
Strong oral and written communication skills.
Self-starter with strong decision-making skills; able to work independently, accept direction, foster cooperation, 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, manage multiple tasks, concentrate on details, and organize resources.
Knowledge of ethical standards for overdue-account follow-up and of credit and collection principles, regulations, and standards.
Ability to analyze medical records and identify billable services.
Ability to meet the stated physical demands, including repetitive data entry, frequent lifting or moving of up to 10 pounds, and use of hands-free headsets for substantial phone work.
Ability to work overtime as needed.

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.
Reconcile patient accounts, identify and correct errors including overpayments, and confer with the Billing and Reimbursement Supervisor on 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 ensure 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 and keep current with third-party payor bulletins, guidelines, and requirements.
Follow safety policies, participate in safety training, adhere to billing requirements, and maintain confidentiality under HIPAA guidelines.