Insurance Specialist

Overview

Responsible for managing and performing efficient and effective Accounts Receivable functions for DCH Regional Medical Center, Northport Medical Center, Fayette Medical Center, DCH Home Health and Home Medical Equipment. Responsible for accurately and timely reviewing, collection of all assigned billed insurance claims. Required to maintain individual and departmental goals for discharged and final billed accounts/claims for AR Aging, AR Days, Cash Collections, etc.

Responsibilities

1. Reviews and follows-up for claims processing/collection on all assigned billed insurance claims on a daily basis using Meditech, Optum, payer websites, and other software programs utilized in the Patient Accounts Department.
2. Ability to research and work assigned claims in a billed and unpaid status.
3. Accountable for productivity to meet individual and departmental goals. AR Aging AR Days, Cash Collections, etc)
4. Responds to and works with other DCH departments (Patient Access, Case Management, Medical Records, etc.)
5. Maintain professionalism and customer service on all interactions.
6. Makes recommendations to implement improved processes.

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook.
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Qualifications

High School education or equivalent is required. One year or more of related experience in a Healthcare Business Office preferred. Knowledge of insurance types related to claims billing and follow-up such as governmental, HMO, PPO, Commercial, etc. Knowledge of federal, state, hospital, and departmental rules and regulations for compliant Healthcare claims filing and reimbursement preferred.

Proficient in personal computer skills. Very good interpersonal/communication skills, customer service skills and history of good attendance required

Must be able to read, write legibly, speak, and comprehend English.


WORKING CONDITIONS

WORK CONTEXT

Interpersonal relationships:


Job requires daily phone and/or face to face communication with co-workers and/or outside sources.

Physical work conditions:

Working indoors in a cubical area, sitting 80% of the time, standing 5%, kneeling 2.5%, squatting/crouching 2.5%, stooping 5%, and walking 5%. Activities include lifting of 35 lbs. maximum which would be a two (2) person lift, frequent lifting and/or carrying 20 lbs. Ability to push or pull over carpet floors, concrete ramps and on varied surfaces, a four wheel cart with 50 lb. of paperwork.

Filing ledgers or finding ledgers requires reaching, pushing, pulling, and extending the hands and arms in any direction. Stooping and bending the body forward by bending the spine at the waist. To reach lower areas requires kneeling by bending the legs at the knee or crouching by bending the body downward and/or forward by bending the legs and spine. This is 50% of daily work.

Organizing charts requires handling of papers by holding, grasping and turning, with picking up and pinching as finger movements. This is a repetitious procedure that is constantly being done.

Communication through talking, expressing or exchanging ideas by means of the spoken word. Hearing; perceiving the nature of sounds of the ear in order to communicate. Seeing; use of vision to determine characteristics of objects, depth perception, color vision with the ability to distinguish color, coding ledgers, near/far activity of 100% daily.

Mental Capability to maintain patient confidentiality 100% of the time.


Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.

Structural job characteristics: Job requires 16-40 hours of repetitive work on desktop, per week.


PHYSICAL FACTORS

• The Americans with Disabilities Act (ADA) requires the job description to document physical factors, including ability, activities, and requirements.

• Ability: Must be able to sit for extended periods of time and lift boxes up to 20 pounds.
• Activities: Job requires ability to communicate through spoken word, ability to use fingers for data entry
• Requirements: Please indicate the physical requirements of the job as one of the following:
  • Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.

OTHER JOB FACTORS

• Job requires being reliable, responsible, and dependable, and fulfilling obligations
• Job requires a willingness to take on responsibilities and challenges
• Job requires being open to change (positive or negative)
• Job requires analyzing information and using logic to address work-related issues and problems
• Job requires being careful about detail and thorough in completing work tasks
• The ability to remember information such as procedures.
• The ability to understand information presented through spoken word or presented in writing.
• The ability to communicate in speaking so others will understand.
• The ability to tell when something is wrong. It does not involve solving the problem, only recognizing the problem.
• The ability to concentrate on a task over a period of time without being distracted.
• The ability to shift back and forth between two or more activities or sources of information.
• The ability to make fast, simple, repeated movements of the fingers, hands, and wrists
• The ability to focus on a single source of sound in the presence of other distracting sounds
• The ability to speak clearly so others can understand you.
• The ability to identify and understand the speech of another person
• Must be results oriented,
• Must be able to work independently with little or no supervision.
• Must be able to work well with others.