Patient Insurance Specialist

Job Summary

Maximize client reimbursement through accurate and timely entry and processing of patient demographic information in accordance with client, company, and compliance standards. This includes searching multiple resources to obtain correct patient demographics and insurance in order to submit claims for reimbursement.

Major Responsibilities/Activities

• Using various defined resources along with sound judgment and critical thinking, enter direct data from EPIC and/or other hospital billing software into EMS|MC billing software ensuring adherence to client, company, and compliance standards.
• Check various insurance websites to discover and verify patient insurance maximizing reimbursement.
• Updating patient insurance and/or demographic information accurately from various databases.
• Ensure strict compliance with company standards regarding patient matching when adding patient information to avoid inaccurate updates.
• Provide proactive and routine feedback to Claims Management Supervisor regarding any deficiencies, variances, and/or other issues identified during the billing process, including variances with incoming inventory. 
• Process all assigned pending and rejected claims in a timely and accurate manner.
• Exhibit strong customer service skills to build and maintain internal relationships in order to best address client needs.
• Meet or exceed contracted client service level agreements (SLAs) concerning turn-around-times and compliance standards on a consistent basis. 
• Conduct all job tasks, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations. 
• Consistently support and demonstrate the company mission and values. 

Other Responsibilities/Activities

• Perform other necessary tasks as assigned. 
• Working additional assignments for all hospital data as assigned.
• Involvement in special projects or meetings as directed. 
• Provide backup assistance to other team Coding Specialist and Revenue Cycle Specialist as needed or when hospital data backlog is complete.
• Provide backup assistance to Customer Service department as needed or when hospital data is complete.

Performance Success Factors

Maintain or exceed specified performance standards for each client, to include but not limited to Contracted Service level Agreements, A/R Aging, Net collection Percentages, and Average Cash per Trip.

Required Education, Skills, & Experience

• High School Diploma 
• At least one-year experience in health care office, production, or clinical environment or comparable classroom experience
• Strong comfort level learning new computer programs and software at a rapid pace 
• Self-motivated, goal oriented, and takes ownership of work
• Ability to learn, understand and work within specific client requirements 
• Ability to learn, understand and apply applicable HIPAA, Medicare, Medicaid, insurance, and liability regulations/guidelines 
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
• Willing and able to receive positive and negative feedback and apply it to work environment in an appropriate and effective manner 
• Strong internal customer service skills 
• Good verbal and written communication skills 
• Positive interpersonal skills with the ability to function well within a cross- functional team setting and independently 
• Detail oriented with strong desire for accuracy 
• Must be able to manage time and maintain focus, concentration, and productivity while performing repetitive and sometimes mundane work 
• Strong, accurate data entry skills

Preferred Education, Skills, & Experience

• Prior EMS billing or EMS or healthcare revenue cycle experience
• Detailed knowledge of Medicare, Medicaid, Insurance, and patient claims
• Prior data entry experience 
• Proficient in EMS|MC billing software
• Experience in working in Hospital data base such as EPIC 

Working Environment/Physical Requirements

• General Office Environment
• Typing /entering data almost continuously 
• Sitting for long period of time, some standing, some light lifting 
• Use of basic office equipment such as fax, printer, copier, telephone

Pay range: $15.00 - $17.00/hour, with final compensation based on the candidate’s qualifications, experience, and business needs. Individuals in this role are eligible to participate in a discretionary bonus plan and a comprehensive benefit package, including a retirement plan, health coverage, and paid time off. Visit https://emsmc.com/careers/ to explore our total rewards package.   

Employees must be able to perform the essential functions of this position. Reasonable accommodations will be provided to qualified individuals with disabilities as needed to support their ability to perform these essential functions. If you require an accommodation for this position or to participate in the application process, please contact HR at humanresources@emsmc.com.

The responsibilities and duties outlined in this job description are not exhaustive and may be subject to change to meet the needs of the business. This job description is not an implied contract of employment and does not alter the at-will employment relationship.

Applicants must be authorized to work in the United States now and in the future; this role does not offer current or future visa sponsorship.