Insurance Specialist - 36 hrs/wk, 1st shift

PURPOSE OF THIS POSITION

The purpose of the Insurance Specialist is to direct and coordinate the overall functions of medical billing for procedures performed in the surgery center to ensure accurate billing and payment while improving patient, physician, and other customer relations.  This position acts as a liaison between the facility and payment parties.  Maintains a good working knowledge of all managed care contracting.  Maintains a current payer matrix.  Assists with surgery authorization as needed.  Discusses patient bills/questions and insurance negotiations.

JOB DUTIES/RESPONSIBILITIES

Duty 1: Bills insurance for medical services

Duty 2: Coordinates reimbursement activities with payers.

Duty 3: Resolves financial conflicts appropriately and professionally.

Duty 4: Receives patient treatment codes to use in assembling reimbursement claims.

Duty 5: Creates reimbursement claims and transfers to third-party payers.

Duty 6: Assists with the transcription, coding and billing.

Duty 7: Discusses all insurance and billing questions with the patient.

Duty 8: Investigates all claim denials by third-party payer.

Duty 9: Maintains insurance matrix.

Duty 10: Accepts full responsibility for his/her actions.

REQUIRED QUALIFICATIONS

• High School diploma or GED equivalent.
• Previous experience in medical business office.
• Knowledge of basic medical terminology.
• Knowledge of A/R and A/P. 
• Familiarity with generally accepted accounting principles. 
• Proficiency with Microsoft Office Suite.
• Able to work independently, manage multiple priorities, detail oriented, willing to flex hours to meet facility needs and able to follow a schedule and manage one’s own time.
• Positive service-oriented interpersonal and communication (written and verbal) skills required.
• Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient status.  Must be able to interpret the appropriate information needed to identify each patient’s requirements relative to their age-specific needs and to provide the care needed as described in the area’s policies and procedures.

PREFERRED QUALIFICATIONS

• Knowledge of insurance billing and collections.
• College education preferred.
• Previous medical coding experience.
• Bookkeeping/accounting experience.

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent walking, lifting, bending, squatting, kneeling, twisting and standing. The associate will be required to walk for up to one hour a day, sit continuously for six hours a day and stand for one hour a day. The individual must be able to lift twenty to fifty pounds and reach work above the shoulders. The individual must have good eye-hand coordination and fine finger dexterity for simple grasping tasks. The individual must have excellent verbal communication skills to perform daily tasks. The associate must have corrected vision and hearing in the normal range. The individual must be able to operate a motor vehicle for business travel and community involvement.