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Medical Insurance Specialist
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Medical Insurance Specialist
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Job Description:
Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
Review and respond to payer correspondence
Submit appeals as needed for denied claims
Contact insurance companies and navigate payer websites to secure and expedite insurance payments
Resolve patient billing inquiries
Document in detail all actions taken in the accounts receivable system
Meet productivity expectations as outlined by supervisor
Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims
Answer and resolve inbound calls from insurance carriers
Participate in process improvement initiatives as needed
Keep current with Medicare and other third-party administrator regulations and procedures
Manage special projects requested by supervisor or team lead
Perform essential functions with or without reasonable accommodation
Requirements:
High school diploma
1+ year of insurance follow-up including working knowledge of the appeals resolution process
Strong written, and oral communication skills
Analytical and problem solving capabilities with close attention to detail
Excellent organizational and follow-up skills
Thorough working knowledge of revenue cycle management including medical terminology, ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing and collection practices
Ability to read and interpret EOB's
Highly self-motivated, with ability to work independently and meet deadlines
Ability to remain flexible during times of change and adjusts promptly and effectively
Must be able to learn, understand, and apply new technologies
