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Insurance Billing Specialist
This position is: Full Time
Position Location: Lake Charles, LA

Imperial Health

JOB 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.

SUPERVISION REQUIRED: Business Office Manager

SUPERVISION EXERCISED: N/A

ESSENTIAL 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 necessary.

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 electronic transfer.

Follows up on unpaid or improperly paid claims as necessary.

Files/Re-Files insurance claims corrections as necessary.

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 HIPPA guidelines/regulations.

KNOWLEDGE, SKILLS & ABILITIES:

Proficient in typing, filing, and operation of basic office equipment.

Good telephone and patient relations skills

Knowledge of medical billing, claims processing and reimbursement practices.

Knowledge of computer functions and programs.

Knowledge of Medical terminology, CPT and ICD-10 coding.

Ability to read, understand and follow oral and written instructions.

Detail oriented and ability to prioritize work.

EDUCATION REQUIREMENTS:

High school diploma or equivalent.

Some post-secondary education and/or certification helpful.

EXPERIENCE:

Basic keyboarding, computer and general office duties

CPT and ICD-10 coding

Rules and guidelines for insurance billing/coding

Insurance claims filing and rejection resolution

Previous experience identifying and resolving complaints

ENVIRONMENTAL/WORKING CONDITIONS: Office 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.


 

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