TITLE: Insurance Billing Specialist
DEPARTMENT: Business Office
GENERAL SUMMARY OF DUTIES: This position
is responsible for posting and monitoring payments from insurance
companies. The individual will respond
to patient and payer inquiries and concerns.
Perform claims follow-up requirements and special projects as directed.
Will perform other related duties as needed to maintain department cost
containment, efficiency, and quality of performance.
FUNCTIONS: The following description of job responsibilities
and performance expectations is intended to reflect the major responsibilities
of the job, but is not intended to describe minor duties or other
responsibilities as may be assigned from time to time.
Demonstrates a commitment to the basic concepts of
continuous quality improvement.
Communicates effectively, both verbally and in
writing, to staff, patients and insurance companies.
Answer and/or respond to phone inquiries and/or
face-to-face inquiries from patients, staff, and insurance companies in a professional
and timely manner.
Maintains open and positive lines of communication while
utilizing proper chain of command.
Data entry of pertinent information necessary to
filing a clean and accurate claim to an insurance company.
Performs appropriate billing/payment posting
functions as assigned.
Performs tasks associated with paper insurance claim
submission, including copying, preparing and attaching required EOB's from as
Ensures pertinent information relating to patient
accounts and/or payer interaction is documented in the PMS.
Processes account adjustments when applicable,
including reviewing and resolving edits created by internal billing system and
Follows up on unpaid or improperly paid claims as
Files/Re-Files insurance claims corrections as
Processes appeals and performs reimbursement
analysis as needed.
Anticipates potential billing/reimbursement problems
and takes measures to prevent them.
Master all systems computer functions applicable to
duties and maintains proficiency.
Adheres to established department protocols and
demonstrates knowledge of current policies and procedures.
Maintains strictest confidentiality; adheres to all
SKILLS & ABILITIES:
Proficient in typing, filing, and operation of basic
Good telephone and patient relations skills
Knowledge of medical billing, claims processing and
Knowledge of computer functions and programs.
Knowledge of Medical terminology, CPT and ICD-10
Ability to read, understand and follow oral and
Detail oriented and ability to prioritize work.
High school diploma or equivalent.
Some post-secondary education and/or certification
keyboarding, computer and general office duties
CPT and ICD-10
guidelines for insurance billing/coding
Insurance claims filing and rejection
Previous experience identifying and
setting. Frequent telephone calls and
other interruptions, which requires being able to handle a fast-paced work
environment during entire time at work.
Must be able to prioritize multiple projects. Must maintain strict confidentiality and
exercise professionalism when interacting with staff, managers, supervisors,
physicians, external customers, etc.