• FredaJ

Insurance Specialist Job Description

Job Summary-Insurance Specialist Job Description

• Insurance Specialist Job Description responsible for payer and patient account balances being paid timely and remaining current and performs collection activities such as monitoring delinquent accounts, contacting patients for account payment, resolving billing problems, and answering routine to complex account inquiries

Get Paid To Use Facebook, Twitter and YouTube • Performs responsibilities within standard procedures and pre-established guidelines to complete tasks

Key Responsibilities-Insurance Specialist Job Description

• Monitors delinquent accounts and performs collection duties • Reviews reports, identifies denied claims, researches and resolves issues, may perform a detailed reconciliation of accounts, and resubmits claim to payer • Reviews payment postings for accuracy and to ensure account balances are current • Works with co-workers to resolve payment and billing errors • Monitors and updates delinquent accounts status • Recommends accounts for collection or write-off • Verifies existing patients have necessary referral and/or authorization documentation prior to examination date • Contacts and follows up with patient’s physician for any missing or incomplete documentation • Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations

• Answers patient payment, billing, and insurance questions and resolves complaints • May refer patients to Patient Benefits Representative to set up payment plans • Contacts third party payors to resolve payor issues, expedite claim processing, and maximize medical claim reimbursement • Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations • Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records • Proactively identifies processes and procedures and develops tools to improve efficiencies • Performs other duties as requested or assigned

Knowledge, Skills and Abilities-Insurance Specialist Job Description

• High School diploma or equivalent required • Associates degree in Finance, Business or four years revenue cycle experience preferred • Minimum two (2) years insurance resolution experience resolving issues with patients and payers as well as four (4) years combined medical billing and payment experience required • Proficiency with computer systems and Microsoft Office (Word and Excel) required • Demonstrate knowledge of medical coding • Demonstrate knowledge of state, federal, and third party claims processing required • Demonstrate knowledge of state & federal collections guidelines • Must successfully complete required e-learning courses within 90 days of occupying position

Competencies for Insurance Specialist Job Description • Uses Technical and Functional Experience • Possesses up to date knowledge of the profession and industry • Is regarded as an expert in the technical/functional area • Accesses and uses other expert resources when appropriate • Demonstrates Adaptability • Handles day to day work challenges confidently • Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change • Shows resilience in the face of constraints, frustrations, or adversity • Demonstrates flexibility • Uses Sound Judgment • Makes timely, cost effective, and sound decisions • Makes decisions under conditions of uncertainty • Shows Work Commitment • Sets high standards of performance • Pursues aggressive goals and works efficiently to achieve them

• Commits to Quality

• Emphasizes the need to deliver quality products and/or services

• Defines standards for quality and evaluates products, processes, and services against those standards

• Manages quality

• Improves efficiencies

63 views0 comments

Recent Posts

See All