*Insurance AR Specialist*

Job Description

Job Description

Overview

As an Insurance A/R Specialist, this position collects payments for an assigned segment of the insurance accounts receivable and performs collection duties in accordance with established federal and state regulations.

Responsibilities

MAIN:

1. Follows-up with insurance companies and ensures claims are paid/processed.  Works all accounts with understanding of all applicable insurance and/or CMS regulations.
2. Resubmits insurance claims that have received no response or are not on file, in a timely manner according to each insurance’s contracted filing limits.
3. Reviews and appeals unpaid and denied claims as appropriate. This includes analysis of coding, insurance eligibility, contract requirements, etc. that ensures proper billing.
4. Makes changes to demographic and insurance information as necessary in order to produce a clean claim.
5. Researches and prepares insurance credits for refund approval.
6. Prioritize work to maximize turn-around time.
7. Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
8. Maintain an error rate in accordance with departmental policy.
9. Answer and respond to external and internal phone calls in a timely and professional manner.
10. Check and respond to emails in a timely and professional manner.
11. Performs all other assigned duties.

GENERAL DUTIES:

1. Conducts self in accordance with the company’s standard values and policies.
2. Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.

METHOD AND FREQUENCY OF SUPERVISION:

• • Monthly meetings with supervisor. Informal supervision with employee through an open door policy.  Employee is expected to ask questions when needed.

Qualifications

Education:

• High School diploma or equivalent

Prior Experience:

• 2 years medical billing or healthcare insurance follow up experience
• 2 years in denials and collections

Skills and Proficiencies:

• Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Demonstrated computer literacy
• Well-organized with attention to detail
• Ability to read and understand oral and written instructions
• Excellent math skills
• Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.
• Excellent professional customer service skills.
• Have a desire and dedication to work with self-discipline.
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.

Physical Abilities:

• • Ability to sit for long periods. Work requires walking, bending, standing, sitting, and reaching