Insurance Specialist

Reports to Manager. Reviews patient records using medical coding procedures. Examines claims and verifies insurance eligibility. Records any medical charges and other payments or adjustments. Detects coding errors. Assists in educating patients regarding insurance.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Bill Insurance Companies

• Files Partners HMO, Michiana Healthnet, Medicare, Medicaid and other insurance types daily.
• Files all insurance forms for third party liability for Partners, Michiana Healthnet, etc. in order to obtain necessary Explanation of Benefits (EOB's) to bill the secondary insurance company.
• Reviews all Partners, Michiana Healthnet, Medicare, Medicaid, etc. reimbursement details, correct and refile.

Address Insurance with Patients and Companies

• Enter new Insurance companies' diagnosis and procedure codes.
• Answers requests for insurance information and track claims when payment is deferred.
• Answers the many questions phoned in regarding insurance problems.
• Keeps accurate files on Partners, Medicare, Medicaid, BC/BS (and other insurance companies as appropriate) insurance claims and Explanation of Benefits (EOB's).

Medicare/Medicaid Information

• Reviews Medicare/Medicaid bulletins for coding changes.

Education/Training

• Attends meetings regularly to stay abreast of insurance matters.
• Builds a rapport with key people at insurance companies to speak with when problems arise.
• Contribute to the overall effectiveness of the department
• Completes other job-related duties and projects as assigned.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience

• The knowledge, skills, and abilities as indicated below are normally acquired through the successful completion of a High School Diploma or Equivalent. A minimum of 1 to 2 years of insurance billing experience is required. Computer experience and ability to keep accurate insurance records is required.

Knowledge & Skills

• The knowledge of medical terminology in regards to procedure and diagnosis codes, policies, legislation, equipment and professional disciplines.
• Demonstrated communications and interpersonal skills necessary to effectively interact with patients and guarantors.

Working Conditions

• Ability to adapt to change and close working conditions.

Physical Demands

• Prolonged periods of sitting and/or standing and occasional lifting.