Insurance Claim Specialist

GENERAL SUMMARY:

Responsible for the accurate and timely resolution of patient account balances. This includes use of proper billing and insurance guidelines, insurance claims processing, charity care guidelines, collection practices and insurance payment analysis and follow up. Assists patients with billing, insurance questions and account resolution.

PRINCIPAL JOB FUNCTIONS:

1. Commits to the mission, vision, beliefs and consistently demonstrates our core values.
2. Performs daily processes to pull and verify clinical charges; completes patient detail billing; and accurately creates insurance claims in compliance with contractual agreements and written billing guidelines.
3. Performs daily processes to electronically file or mail insurance claims, retrieves and analyzes electronic reports of insurance claims and accounts receivable (A/R) files.
4. Performs the necessary tasks to prepare and send intermittent billing invoices and monthly statements.*Analyzes assigned Explanation of Benefits (EOBs) for accurate reimbursement and contractual adjustment information.
5. Performs follow-up on non-paid insurance claims in a timely manner.
6. Receives and resolves patient billing questions or concerns in an accurate, timely, professional and friendly manner.
7. Follows protocols in communicating and releasing patient protected health and financial information.
8. Completes reconsiderations and appeals as needed.
9. Maintains knowledge of current billing guidelines and third party payer regulations.
10. Ensures all billing forms are completed and are accurate based on billing regulations for the payers to ensure appropriate and timely reimbursements are received and all compliance standards are maintained.
11. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
12. Participates in meetings, committees and department projects as assigned.
13. Performs other related projects and duties as assigned.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associates Degree in a related field preferred. Minimum of one (1) year hospital or medical-related experience required. Prior medical office or hospital insurance processing experience preferred. Prior customer service experience desired.