Insurance Specialist

Richmond Aesthetic Surgery & Dermlounge•Richmond, VA

About The Position

As the Insurance Specialist, you play a pivotal role as your expertise directly contributes to the success of our busy plastic surgery practice and ensures a positive financial experience for our patients. Your responsibilities include checking eligibility for our weight loss patients, obtaining authorizations for surgery and office visits, and sending claim forms through our clearinghouse. You are a proactive problem-solver and a key liaison between patients, our clinical team, and insurance carriers. Your day is dynamic: from meticulously understanding eligibility, securing pre-authorizations, to expertly navigating the complexities of claim submissions.

Requirements

High school diploma or equivalent is required.
Minimum of three years of experience as an insurance specialist with a demonstrated understanding of the in and out of network insurance eligibility and claim submission processes.
At least 1 year in a plastic surgery, dermatology, or similar surgical specialty practice is highly preferred.
Proficiency with practice management software, electronic health records (EHR) systems, TriZetto and Availity or similar insurance clearinghouses.
Excellent written and verbal communication skills and strong attention to detail and accuracy are required.
Strong problem-solving and analytical abilities are essential.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook) is required.
Knowledge of HIPAA regulations is required.

Nice To Haves

Associate's degree in medical billing, healthcare administration, or a related field preferred.
A bachelor’s degree may substitute for some experience.
Experience using NexTech is preferred.

Responsibilities

Verify eligibility for services for our weight loss clinic patients.
Ensure a smooth patient experience by meticulously verifying and submitting the pre-authorization requirements.
Champion accurate and timely reimbursement by expertly preparing and submitting medical claims for specialized plastic surgery procedures and our weight loss clinic visits.
Ensure all claims have been submitted and accepted by the clearinghouse.
Serve as back up and partner to our accounts receivable and billing specialist.
Empower patients by working alongside our Patient Care Insurance and Surgery Coordinator to clarify insurance coverage, financial responsibilities, and payment options.
Stay at the forefront of your field by maintaining up-to-date knowledge of CPT, ICD-10, and HCPCS coding guidelines specific to plastic surgery.
Navigate the evolving healthcare landscape by staying informed about changes in insurance regulations and payer policies, especially the No Surprises Act.
Contribute to continuous improvement by generating and analyzing eligibility and claims reports to identify trends, resolve issues, and uncover opportunities for enhancement.
Foster accuracy and compliance by collaborating with our clinical staff to ensure documentation robustly supports all billing.
Uphold the highest ethical standards by maintaining strict confidentiality of all patient information.
Deliver service excellence daily, meeting and exceeding the expectations of both our team members and our valued patients.
Shape our operational success by contributing to and adhering to best practices in office and insurance administration.
Embrace growth and teamwork by supporting organizational changes with a positive outlook, all while championing our core practice values of excellence, service, and respect.
Be an integral team player by performing other administrative duties as assigned to support the overall success of the practice.