Insurance Specialist - Temporary
About The Position
Responsible for investigating aged insurance claims to determine appropriate action and provide resolution; by determining payment status using account notes, health plan websites and health plan customer service. Determines and facilitates appropriate action for claim resolution and correct financial responsibility via DOFRs (Division of Financial Responsibility), IPA and health plan contacts. Maintaining timely follow-up to ensure claims are corrected/rebilled/appealed within carrier filing limits. Effectively uses detailed documentation in EPM system(s) of all activities undertaken. Help to identify aged claim patterns to identify potential process improvements. Ability to multi-task and comfortable changing priorities as needed.
Requirements
- High School diploma or equivalent required
- 1-2 years Billing in Medical Office / Hospital required
- 1-2 years CPT/ICD-10 guidelines and use of modifiers required
- 1 year Excel and other Microsoft office applications required
- 1-year EMR knowledge required
Nice To Haves
- 2 Years - Business Admin / Healthcare / Related Field preferred
- Certified Medical Reimbursement Specialist CMRS preferred
- Certified Medical Insurance Specialist CMIS preferred
- 1-2 years EPIC EMR preferred
- 1-2 years Division of financial responsibility (DoFR) experience and training capability preferred
Responsibilities
- Maintains timely follow-up on outstanding insurance claims in appropriate EPIC WQs (Work Queues), ensuring claims are billed/rebilled within carrier filing limits
- Effectively takes appropriate action on claim denials to ensure prompt resolution and follows-up on those rebilled, corrected and appealed
- Maintains detailed documentation in software system(s) of all claims & collections activities, including rebills, all follow-up, and related correspondence with carriers, practitioners
- Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues
- Informs Supervisor of problems related to insurance company payments/denials, contract pricing, and works with Supervisor and all parties involved to ensure prompt resolution
- Strong MS Office capabilities to include Word, Excel, and Outlook
- Demonstrated ability to work well in a team environment, follow protocol and workflows.
- Ability to multi-task in a fast-paced work setting, with multiple technology platforms.
- Meets daily A/R target of 35-40 claims daily (on average)
- Work collaboratively with leadership and other team members to improve or challenge processes, provide trending and solutions insights, and support the capability development of the team
- Will be responsible for maintaining spreadsheets assigned by Supervisor
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
