INSURANCE SPECIALIST

Description

Job Summary   

• Identifies status on unpaid 3rd party claims in a timely manner.        
• Uses most effective tools to obtain status so that effectiveness and productivity are maximized.    
• Communicates payment expectations and removes payers stall tactics in a firm but professional manner.        
• Reports problem accounts and/or consistent slow payers to management and provides examples.        
• Involves the patient and/or insured to obtain information needed by payers to process the claim.  
• Conducts three-way calls between patients and payers to address obstacles in getting claims processed.        
• Obtains, or assists in obtaining, any additional documentation needed by a payer to process a claim.        
• Works with their billing partner to identify trends in billing errors, so the edits can be developed to increase clean claim rate.        
• Accurately and thoroughly documents all pertinent events regarding the account.        
• Demonstrates and encourages team behavior and exceptional patient/guest experiences.    
• Upholds and promotes patient safety and quality.         

Qualifications

Education            
High school diploma required or equivalent.                

Experience               
3 years of hospital business office or physician office preferred.                   

Additional Skills/Abilities               
Must be proficient in Microsoft Office Suite of products. Knowledge of ICD, CPT, revenue codes and modifiers is required. Familiarity with payer website and portals is preferred.