Medical Insurance Specialist
Job Description:
- Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
- Review and respond to payer correspondence
- Submit appeals as needed for denied claims
- Contact insurance companies and navigate payer websites to secure and expedite insurance payments
- Resolve patient billing inquiries
- Document in detail all actions taken in the accounts receivable system
- Meet productivity expectations as outlined by supervisor
- Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims
- Answer and resolve inbound calls from insurance carriers
- Participate in process improvement initiatives as needed
- Keep current with Medicare and other third-party administrator regulations and procedures
- Manage special projects requested by supervisor or team lead
- Perform essential functions with or without reasonable accommodation
Requirements:
- High school diploma
- 1+ year of insurance follow-up including working knowledge of the appeals resolution process
- Strong written, and oral communication skills
- Analytical and problem solving capabilities with close attention to detail
- Excellent organizational and follow-up skills
- Thorough working knowledge of revenue cycle management including medical terminology, ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing and collection practices
- Ability to read and interpret EOB's
- Highly self-motivated, with ability to work independently and meet deadlines
- Ability to remain flexible during times of change and adjusts promptly and effectively
- Must be able to learn, understand, and apply new technologies
- Must reside in TN, AZ, FL, GA, or OH
Benefits:
