Insurance Billing & Denials Specialist II

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment from third-party payors and reporting to management on observed trends and issues. Job Relationships Reports to the Insurance Review Supervisor Principal Responsibilities Handle all phone calls and messages received specific to designated insurance area. Update registration screens when requested by patients or as necessary. Review and process all designated insurance vouchers received, rebilling charges not paid and processing adjustments as needed utilizing websites or telephone as necessary. Process all secondary billing as requested by patients or defined by procedure. Distribute incoming insurance mail received and respond to all audits, inquiries and additional information requests. Process corrections/adjustments as necessary to correct the patient's invoice. Process designated insurance reviews when requested to obtain additional payments on claims utilizing websites or telephone as necessary. Analyze and process front-end system edits for correct physician productivity and billing of claims. Analyze and process back-end system edits for correct registration and billing of claims. Analyze and process claims denied through clearinghouse. Investigate and process claims in the insurance work files and/or on the insurance reports. Must report all incidents to immediate Supervisor or Manager. Assist with special projects and assignments as directed. Must attend in-services and training relevant to position. Perform other job duties as assigned. Confidentiality required. Comply with the Springfield Clinic incident reporting policy and procedures. Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy. Provide excellent customer service and adhere to SC Way customer service philosophy. Education/Experience High School graduate or GED required. Previous experience in a medical billing office required. Knowledge, Skills and Abilities Working knowledge of medical terminology preferred. Working knowledge of CPT and ICD-9 coding preferred. Computer, typing and calculator skills required. Must be able to work individually or on a team. Working Environment Office environment, sitting for long periods PHI/Privacy Level

HIPAA1

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