GENERAL SUMMARY OF DUTIES:

This is not a remote position.

Well-versed individual, with the ability to liaison between patients, insurance companies and all of Piedmont HealthCare personnel. Will conduct skillful use of systems, communication, research, assessment and resolution. Professionally perform tasks related to accuracy in health insurance billing and collections of all transactional areas in Piedmont HealthCare patient accounts. The ability to remain focused and accurate under deadline pressure. The Insurance Specialist will retain and provide essential information to resolve any inaccuracies generated in Piedmont HealthCare patient accounts. Overall, committed to the Mission and Vision of Piedmont HealthCare’s establishment.

REQUIREMENTS:

• Understanding of CMS Compliance regulations.
• Understanding of how to read Explanations of Benefits (EOB's).
• Knowledge of billing and coding terminology including CPT, ICD-10 and HCPCS
• Knowledge of healthcare billing procedures.
• Knowledge of payer policies and understanding this requires continuous reading, and content comprehension.
• Thorough claim follow-up with persistence.
• Ability to communicate professionally verbally and written.
• Extensive experience with claim appeals process
• Knowledge of insurance claims processing.
• Basic understanding of insurance fee schedule.

ESSENTIAL FUNCTIONS:

• Communicate with different insurance companies to gather distinctive information about contractual requirements, coverage, eligibility, prior authorizations, co-pay levels, deductibles, payments, adjustments, etc.
• Thorough understanding of health insurance denials and claim follow up comprised from services rendered per Piedmont HealthCare contracts.
• Communicate with satellite offices to research and configure payment and adjustment activity in patient accounts.
• Willingly assist with all customer service related functions to grow business and create positive patient relations.

EDUCATION:

High School Diploma required, with some college preferred. Additional specialized health care related training preferred.

EXPERIENCE:

Healthcare experience required

KNOWLEDGE AND SKILL REQUIREMENTS:

• Strong knowledge of the Piedmont HealthCare Compliance Plan including HIPAA regulations and OSHA guidelines/standards.
• Competent in the functionality of our practice management and patient intake system – Athena Group Management, Phreesia and electronic medical records.
• General knowledge of insurance filing, reimbursement, and coding (CPT/ICD 10 specifically).
• Experienced in using Microsoft Office 365 tools (Word, Excel, Outlook).
• Proactive in planning, organizing, and strategizing.
• Excellent communication and writing skills.
• Self-reliant in taking initiative and exercising independent judgment.
• Ability to adapt and deal courteously with internal and external customers in a fast-paced environment.

ENVIRONMENTAL/WORKING CONDITIONS:

Normal office environment

PHYSICAL/MENTAL DEMANDS:

Requires prolonged sitting, some bending, stooping and stretching. Requires eye/hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing, speaking voice, and eyesight to prepare and communicate letters and reports. Requires the ability to discuss sensitive matters with patients, staff members and physicians. The position requires the ability to maintain composure when dealing with difficult people and situations.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve