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Insurance Specialists are highly focused on the resolution of insurance processing errors and denials and work to resolve hospital and physician billing challenges. You will utilize your expertise in patient billing, claims submission, and payer guidelines (Medicare, Medicaid, &, commercial insurers) to effectively work with insurance companies, resolve issues, and ensure accurate and timely payments.
Responsibilities
Reduce outstanding accounts receivable by managing claims inventoryâ¯
Speak to patients and insurance companies in a professionalâ¯manner regarding their outstanding balancesâ¯
Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for servicesâ¯
Request, input, verify, and modify patient’s demographic, primary care provider, and payor informationâ¯
Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc.â¯
Answer questions by phone and provide quotes for services; identify financial resources, etc. in accordance with the client policies and proceduresâ¯
Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc.â¯
Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agenciesâ¯
Work with Claims and Collections in order to assist patients and their families with billing and payment activities
Requirements
High School Diploma/GED
3+ years of Denials Management experience
2+ years Medical Billing/Follow-up experience
Medicare, Medicaid, and commercial payor experience
Experience with Professional Billing and CMS-1500
Proficiency with PC-based applications (Microsoft Outlook, Word, and Excel)
Download speed of 30MB or higher & upload speed of 10MB or higher are REQUIRED. (you can test your speed here: https://speedtest.net/ )
Access to a Secure and Private workspace (a space in which no one can hear or see you as you may have protected health information on your screen or you may say names, social security numbers or other PHI)
Must be legally authorized to work in the United States without sponsorship
As a condition of employment, a pre-employment background check will be conducted
Nice-to-haves
Experience using Epic EHS platform
Knowledge of CA payers (including Medi-Cal)
Benefits
Comprehensive paid training
Medical, dental, and vision insurance
HSA and FSA available
401(k) with company match
Paid Wellness Time and Holidays
Employer paid life insurance and long-term disability
