Job Title: Insurance Verification and Billing Specialist
Location: Bennett / Beach
Hours: Monday – Friday / 8:00 AM to 5:00 PM (occasional late / early hours and weekend hours)
Reports to: Insurance / Billing Dept Team Lead
Salary: Competitive salary and benefit package provided. All inquiries are confidential.
Health insurance specialists are responsible for verifying eligibility and benefits, obtaining prior authorizations, processing medical insurance claims, medical coding, and maintaining patient records in various health care settings.
- High School Diploma or equivalent.
- Must present a professional image.
- Excellent organizational skills and ability to effectively multitask.
- Strong computer skills and the ability to navigate Microsoft, EMR, Insurance websites.
- Superior interpersonal and communication skills both oral and written.
- Motivation and diligence to work independently throughout the day.
- Basic math and accounting
** You may be asked to be responsible for some or all of these aspects in the Insurance and Billing Department **
MEDICAL BILLER AND CODER – use medical codes to document patient diagnoses and treatments.
- Reading and analyzing patient records
- Determining the correct codes for patient records
- Using codes to bill insurance providers
- Interacting with physicians and assistants to ensure accuracy
- Keeping track of patient data over multiple visits
- Managing detailed, specifically-coded information
- Maintaining patient confidentiality and information security
PAYMENT POSTING SPECIALIST – Interprets Explanation of Benefits (EOB) and is responsible for payment posting and adjustments to patient accounts as identified in EOB and balances posted payments daily. Identifies, analyzes and corrects payment posting errors. Posts “denials” into the system using appropriated codes. Responds to inquiries from patients and third parties as required communicates daily with supervisor on payer trends identified.
- Posts payments received and adjustments as identified by insurance explanation of benefits.
- Corrects payment posting errors.
- Balances posted payments at the end of the day.
- Posts Denials into systems with appropriate denial codes.
- Responds to third party inquiries; researches and resolves simple to moderately complex issues and refers complex issues to supervisor.
- Maintains knowledge and proper utilization of transaction codes.
- Ensure confidentiality of all patient accounts by following HIPAA guidelines.
- Adheres to compliance of CMS and other payer guidelines.
- Instills current department policies and procedures.
- Communicates daily with management on payer trends identified.
- Performs other duties as assigned.
MEDICAL INSURANCE VERIFICATION – The insurance verification specialist is responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s insurance plan.
- Navigating and utilizing insurance websites to obtain and interpret details of eligibility and benefits for procedures/surgeries.
- Calling insurance and determining patient’s out-of-pocket responsibility for surgery/procedure and obtaining precertification/prior authorization as needed
- Documentation in patient chart/surgical paperwork
- Explain to patient insurance coverage and benefits as they pertain to scheduled surgery/procedure.
- Collecting determined patient payment.
ACCOUNTS RECEIVABLE CLERK – Secures revenue by verifying and posting receipts; resolving discrepancies.
- Posts customer payments by recording cash, checks, and credit card transactions.
- Posts revenues by verifying and entering transactions form lock box and local deposits.
- Updates receivables by totaling unpaid invoices.
- Maintains records by microfilming invoices, debits, and credits.
- Verifies validity of account discrepancies by obtaining and investigating information from sales, trade promotions, customer service departments, and from customers;
- Resolves valid or authorized deductions by entering adjusting entries.
- Resolves invalid or unauthorized deductions by following pending deductions procedures.
- Resolves collections by examining customer payment plans, payment history, credit line; coordinating contact with collections department.
- Summarizes receivables by maintaining invoice accounts; coordinating monthly transfer to accounts receivable account; verifying totals; preparing report.
- Protects organization’s value by keeping information confidential.
- Updates job knowledge by participating in educational opportunities.
- Accomplishes accounting and organization mission by completing related results as needed.