Insurance Specialist - CPAR Required - 8 AM - 4:30 PM Eastern

Northeast Georgia Health System•Remote - Georgia, GA

About The Position

The Insurance Specialist serves as a key contact for patient questions related to insurance claims, denials, coding, re-determinations, attorney settlements, and retro authorizations. The role resolves credit balances and payment discrepancies by reviewing prior billing activity and correcting errors. The specialist serves as a subject matter expert on payer guidelines, focusing on underpayment recovery, aged denial resolution, and supporting claim adjudication. The position requires a high school diploma or GED, CPAR certification, and CPB or CPC certification. CPB or CPC may be obtained within one year of hire. At least three years of medical billing and/or medical coding experience is required. The specialist must understand revenue cycle functions, billing regulations, patient collections, denial follow-up, EOB interpretation, and HIPAA requirements, and must be proficient with the computer programs needed for the role. The role is scheduled for an eight-hour morning-to-afternoon shift, 8:00 a.m. to 4:30 p.m. Eastern. Physical demands include occasionally lifting and carrying up to 20 pounds, frequent vision-intensive work, and occasional kneeling, stooping, bending, standing, walking, pushing, and pulling. The job requires reading, writing, reasoning, talking, and keyboarding.

Requirements

Certified Patient Account Representative (CPAR) certification.
Certified Professional Biller (CPB) or Certified Professional Coder (CPC) certification; CPB or CPC may be obtained within one year of hire.
High school diploma or GED.
At least 3 years of medical billing and/or medical coding experience.
Knowledge of revenue cycle functions, including registration, coding and charge posting, payment posting, and financial assistance.
Thorough knowledge of patient collections, governmental and commercial billing regulations, denial follow-up procedures, and interpreting EOBs to resolve posting and billing issues.
Proficiency with a personal computer and the programs necessary to perform job duties, including the ability to toggle between systems efficiently.
Strong listening, problem-solving, and customer service skills, including the ability to remain calm and professional in stressful situations.
Excellent verbal and written communication skills and strong telephone proficiency.
Ability to work independently within guidelines.
Thorough knowledge of HIPAA regulations to protect patient health information.
Ability to read, write, reason, talk, and keyboard.
Ability to meet the stated physical demands, including occasionally lifting and carrying up to 20 pounds.

Responsibilities

Verify and update patient insurance coverage, review patient accounts, and rebill claims as appropriate.
Meet or exceed quality and productivity standards established by SPRC leadership.
Follow scripting and departmental guidelines to provide quality service.
Research and resolve patient inquiries through phone calls and electronic messages, de-escalate complaints, and escalate issues to leadership when appropriate.
Attend weekly, monthly, quarterly, annual, and department meetings.
Work with patients or guarantors to identify or add insurance, third-party sponsorship, and settlement information.
Maintain knowledge of health insurance, EOBs, collection processes and techniques, and NGHS Financial Assistance Programs.
Adapt to organizational and technological changes.
Perform other assigned duties, including working queues, handling itemized statement requests, and providing Detail Bills, 1500s, and UBs.
Support departmental teamwork by assisting coworkers, contributing ideas, collaborating on problem-solving, and identifying trends affecting patient billing and customer satisfaction.
Liaise with patients and payers to resolve insurance billing issues, obtain required documentation, and review EOBs for payment accuracy.
Contact insurance companies by telephone and websites to reprocess aged facility and professional claims.
Identify and correct posting errors, underpayments, and denials within the appeal window; resubmit claims for late charges and other issues.