What are the responsibilities and job description for the Insurance Specialist position at PRAIRIE VIEW INC?
POSITION RESPONSIBILITIES:
- CLAIMING
- COLLECTING
- POSTING PAYMENTS
- PLATFORMS
- MISCELLANEOUS
- PROFESSIONAL DEVELOPMENT
- PERFORMANCE IMPROVEMENT
- EMPLOYEE CONTRIBUTES TO POSITIVE WORK ENVIRONMENT
CPA 1: CLAIMING*
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- Work with third party vendor/internal team to obtain missing or incorrect information needed for claiming/billing and reimbursement.
- Work with Patient Account Specialist to obtain missing or incorrect information needed for claiming/billing, statements and reimbursement.
- Assist on projects with third party billing vendor/internal team to maximize reimbursement and get claims paid timely and correctly.
CPA 2: COLLECTIONS *
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- Follow up on outstanding claims with third party vendor and internal teammates to facilitate timely payment.
- Insurance correspondence. Match correspondence with claims, process denials, discounts, and refunds if appropriate and notify financial counselor. Notify medical records of requests for information needed for payment.
- Work with Patient Account Specialist regarding questions about eligibility, coverage, insurance addresses, payments, etc.
- Work with third party billing vendor/internal team and/or insurance companies when questions or problems with payments to facilitate correct reimbursement.
CPA 3: POSTING PAYMENTS*
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- Posting of assigned payments from insurance companies and other funding sources, including self pay and contract payments.
- Notify Patient Account Specialist of any eligibility changes identified through claiming process or denials.
CPA 4: PLATFORMS*
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- Demonstrates the ability to read account ledgers and post charges/payments/corrections as needed MyAvatar.
- Demonstrates the ability to work in various website, including but not limited to: Waystar, Availity, WPS/GHA, KMAP, and SFTP.
- Demonstrates the ability to work accounts, payments, and claims from Excel spreadsheet.
CPA 5: MISCELLANEOUS *
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- Demonstrates an ability to perform a variety of duties, maintains flexibility as department needs change.
- Demonstrates the ability to perform work in an accurate and timely manner.
- Emphasizes a standard of excellence in all work endeavors.
- Demonstrates accuracy, thoroughness and dependability at all times.
- Demonstrates a team approach by working cooperatively with others and other departments.
CPA 6: PROFESSIONAL DEVELOPMENT *
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- Will actively participate as a member of the Patient Accounts staff by communicating accurate and relevant information to other staff.
- Work cooperatively with supervisor to complete professional development plan.
- Attend staff meetings as requested by supervisor.
- Attend workshops to enhance performance and education, pertinent to job, as time and resources allow.
- Participate in continuing education activities and required in service (such as Infection Control, etc.) as requested, to enhance and improve job performance.
- Utilize Relias Learning site to increase awareness in areas required, as well as to enhance skills used in position.
CPA 7: PERFORMANCE IMPROVEMENT
Participate in organizational performance improvement activities. Be familiar with Performance Improvement Initiatives and goals in work area. Annually review the Performance Improvement Plan.
CPA 8: EMPLOYEE CONTRIBUTES TO POSITIVE WORK ENVIRONMENT WITH COWORKERS AND CUSTOMERS
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- Treats others with respect and dignity.
- Maintains a flexible response to organizational and customer needs.
- Understands role as part of larger team that extends beyond the individual work area.
- Performance is consistent with Prairie View’s mission statement.
To foster healing and growth in individuals and communities by providing behavioral and mental health services with compassion, competence, and stewardship in the spirit of Christ.
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- Performance is consistent with Prairie View’s values.
Continue our heritage as a Christian, caring community, Prairie View honors these values that guide our decision making:
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- Advocacy for those whose voices are not strongly or widely heard
- Quality and competence leading toward excellence
- Respect for the beliefs of individuals and communities of faith
- Communication with integrity, dignity, and sensitivity
- Actions based upon justice, grace, acceptance, and forgiveness
- The sustainability of the organization.
- Performance is consistent with Prairie View’s compliance program.
- Takes responsibility to challenge and evaluate departmental and institutional strategies and actions without personalizing.
- Maintains confidentiality in all aspects of position.
- Uses problem situations as learning opportunities.
- Brings energy and positive attitude to the work place.
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POSITION QUALIFICATIONS:
- Minimum Education: High School degree required
- Minimum Experience: Previous healthcare insurance/billing experience
- Good organizational skills required
- Basic accounting knowledge preferred
- Proficient at basic keyboarding/word processing skills
- Knowledge and experience of Microsoft Word, Outlook, and Excel required; PowerPoint preferred
- Strong communication skills (written and verbal) required
- Ability to prioritize work load with multiple priorities required
- Attention to detail required
- Ability to analyze data to identify areas for improvement in the billing process preferred
- Ability to work independently and make decisions required
- Ability to maintain an up to date knowledge of industry trends in healthcare legislation, regulations, and processes preferred
- Ability to work with others across the organization to ensure accurate billing of claims required
- Must be able to pass both a Kansas Bureau of Investigation Screen and Central Registry Screen