SUMMARY DESCRIPTION

The Insurance Specialist is responsible for proper execution of daily business office operations (i.e., electronic and paper claim submission, claims follow-up, appeals and posting remittances).

RESPONSIBILITIES

• Responsible for working and following up on AR (over 30 days) for assigned payers.
• Post electronic and paper remits.
• Appeal all appropriate claim denials within 24 hours of receipt of the denial.
• Works credit balances and issues a refund request when appropriate to Director of Revenue Cycle Management.
• Participate in the orientation and training of all new staff members.
• Maintains detailed knowledge of the Practice Management System.
• Maintains up-to-date knowledge of changes in unique carrier requirements for clean claim submission. Notifies Director of Revenue Cycle Management (DRCM) any patterns/trends in denials for specific CPT/ICD-9 codes.
• Notifies DRCM of any appeal that is denied before a decision is made to write off the charge.
• Keeps abreast of yearly changes made to CPT and ICD-10 codes.
• Assist patients with questions regarding their accounts.
• Gives DRCM feedback on denials/errors that would help educate front office staff on proper retrieval of demographic information.
• Maintains an open line of communication with the DRCM and co-workers.
• Attend department and company staff meetings.
• All other duties as assigned.

QUALIFICATIONS

• High school graduate.
• Minimum of one year of work experience in a medical billing office or related education.
• Medical terminology, CPT, and ICD-10 coding experience preferred.
• A team player who works well under pressure and who can communicate clearly in person and/or on the phone.
• Knowledge of basic insurance guidelines and an understanding of the appeals process.
• Ability to organize and prioritize tasks effectively.
• Experience with a practice management system, preferably Allscripts, which includes electronic remittance posting and knowledge of electronic medical records.

ENVIRONMENTAL/WORKING CONDITIONS

• Medical office setting.
• Well-lit and well-ventilated adequate space.
• Some exposure to communicable diseases and other conditions commonly found in a clinical environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting for extensive periods. 
• Must be able to view a computer screen for an extended period.
• Light lifting required up to 15 lbs.
• Requires manual dexterity sufficient to operate a keyboard, operate a calculator, telephone, copier, and such other equipment, as necessary.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job.   This document is not intended to be an exhaustive list of all responsibilities, skills, and working conditions for individuals classified in this manner.  An employee may be assigned or requested to perform other related duties.