Insurance Specialist

Insurance Specialist/Receivable

The Insurance Specialist/Receivable is responsible for maintaining current insurance practices, requirements, and forms; verifying proper reimbursement is received for services provided; processing and following up insurance claims; documenting and coding information, interpreting medical records and analyzing, recording, and reconciling accounts receivable transactions.

Essential Duties and Responsibilities:

Primary duties:

• Reviews and analyzes discrepancy reports and other information concerning payments received for various types of insurance or benefits programs.
• Bill procedures within two days of service.
• Determines cause of discrepancies resulting from payments made through electronic transfers or other methods; researches appropriate records or documents as needed to verify payments due and identify any changes in enrollment or status.
• Notifies insurance/benefit coordinators, policyholders, members, or others, as needed, concerning actions required to correct discrepancies, adjust accounts, or other requirements.
• Prepare statements and other documents; initiates action for payment of patient refunds; review and process claims for reimbursement.
• Records accounts receivable transactions and benefit eligibility and creates billing records.
• Review patient accounts and determine appropriate billing distributions.
• Posting payments received directly from policyholders and insurance companies.
• Responding to inquiries concerning policies and procedures.
• Review and follow up on past-due accounts.
• Verify insurance breakdown accordingly.
• Enter data in the document center and attach it to the patient file updating the billing type.

Expectations:

Insurance Specialist is expected to manage the entire process in an efficient way, resulting in maximizing insurance collections and minimizing write-offs. Performing daily audits and corrections to ensure claims are not held up in the clearing house and responding to denied or underpaid claims. Resubmitting claims with the additional requested information within three days and sending invoices on monthly bases. Maintain accounts receivables up to date with no more than 90 days past due.