Insurance Specialist II

Inland Imaging•Spokane, WA

1d•Hybrid

About The Position

The Insurance Specialist II will work complex inpatient/outpatient claims, including procedures and surgeries, to secure reimbursement from governmental and private payors. This position is Full Time, Monday-Friday 7am-3:30pm with a half an hour lunch. The work location will be at our business center located in the hospital district near downtown Spokane, with free parking. This position does have the potential of being a hybrid (combination of in office and work from home) following training. The Insurance Specialist II addresses a large volume of unpaid or incorrectly paid/denied claims to secure reimbursement. This role performs medical billing functions as related to both professional and outpatient surgery claims. It involves reviewing and resolving claim edits and rejections and resubmitting clean claims. The specialist also reviews unpaid claims, including denials, and appropriately resolves and resubmits adjusted/corrected claims, and researches and/or resolves overpayments/credit balances.

Requirements

High School Diploma/GED required.
At least five years of experience in billing medical claims to either government or commercial insurers.
Must be willing to work in office with possibility of hybrid
Must be able to pass a background check required by RCW 43.43.830-840 to work with children under the age of 16, developmentally disabled persons or vulnerable adults
Employees must not be included on the LIST OF EXCLUDED INDIVIDUALS provided by the Department of Health & Human Services, Office of the Inspector General (OIG).
Eligible employees must be able to pass a post-offer, pre-employment drug test which includes marijuana.

Nice To Haves

Two-year medical billing course successful completion is desired.
Preferably has experience in billing Pluvicto, Y-90, Lutathera, Kyphoplasty, but will accept equivalent in physician, clinic, or ASC billing.
Working knowledge of government hospital payment methodologies including OPPS, Critical Access Hospital method II, or both preferred.
CPT, HCPCs and ICD-10 coding experience preferred.
Experience with electronic claims scrubbing and clearinghouse systems preferred.
A certification related to healthcare claims processing from a recognized industry accrediting body (AHIMA, AAPC, etc.) desired, but not required
Experience with the following computer applications is highly desired: Microsoft Office products (Outlook, Word, Excel), Internet/Intranet, Meditech, Epic or other hospital or physician EHR/accounting system.

Responsibilities

Responsible for all phases of billing to government and commercial insurers, including initial billing of clean claims electronically or on paper, subsequent follow up on unpaid claims to the point of payment or resolution of the claim, and resolving credit balances.
Prioritizes assigned worklist of aged accounts appropriately and works on aging accounts to their resolution.
Reviews and processes electronic claims, claim edits and deletions appropriately and compliantly.
Interprets billing regulations accurately and within federal, state, and third-party billing regulations and policies.
Utilizes various client host systems in order to research and rebills claims.
Verifies reimbursement to make sure payers are reimbursing according to fee schedule
Other special projects and duties as assigned.
Treats all clients with dignity and respect
Provides excellent customer service
Conforms to Joint Commission and HIPAA regulations
Complies with PHI (Protected Health Information)
Demonstrates the Inland Imaging Core Values: Show We Care, Do The Right Thing, Maximize Individual Potential, Always Aim Higher