The Insurance Specialist I is responsible to follow up on new and outstanding accounts in a professional and consistent manner to ensure payment is received by Insurance for services rendered. Accurately documents account statuses, notes, etc. in the AR management system. Maintains compliance with FDCPA, FCRA, HIPPA plus local, state and federal regulations. Demonstrates attention to detail, achieves the determined production and quality expectations and works well under pressure.

• Responsible for the timely follow-up and collections of all billed, MCR, MCD, and Commercial insurance accounts supplied through AR program by utilizing online tools, and making contact with payers over the phone and through payer websites.
• Updates the patient account record to reflect the current actions that had been taken, and making sure to thoroughly document what actions were taken to resolve the issue and to collect the payment.
• Reviews EOB’s/payments and verifies that accounts are being paid according to contract and determine patient responsibility.
• Processes non-clinical appeals on accounts when appropriate. Sends requests to medical records as needed.
• Accountable for making sure responsible parties are contacted in a timely manner if additional information is required for billing purposes.
• Processes denials and applies appropriate contractual adjustments if needed.
• Identifies problem accounts as well as claims processing delays and escalates to management.
• Attends/participates in all available educational opportunities to stay in compliance with insurance and government regulations.
• Responsible for reviewing overpayment notices and request and determining if they are accurate and if so, submit for a refund.
• Identifies COB issues and updates patients accounts accordingly, insuring all visits for that patient are updated and reviewed for processing of claims.
• All other duties as assigned.

Education

• High School Diploma/Equivalent

Experience

• 0-1 years Insurance, Billing, or Registration

Preferences:

• 1 year: Insurance follow up in a hospital, physician’s office or other medical facility.
• Knowledge of ICD10, CM, and CPT4 coding
• Familiar with billing forms UB04 and HCFA 1500
• Two years Insurance follow up experience in either a hospital, physician’s office or other medical facility.

Additional Information:

• Skills and Abilities: Familiar with billing forms UB04 and HCFA 1500 preferred. Knowledge of ICD10 CM AND CPT4coding preferred.