Insurance Specialist II - Corporate Patient AR Management - Full Time

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    "ExternalDescriptionStr": "<p><strong>Position Summary:&nbsp;</strong></p><p>Fulfills all requirements of &nbsp; Insurance Specialist I, as well as serving as a group leader by participating in staffing and employment issues. &nbsp;Serves as a resource specialist within the department. &nbsp;Trains Insurance Billing Specialists I and related support staff. Works closely with Director, Manager, Supervisor and Application Analyst on day to day priorities and to maintain a high level of integrity within the unit. Takes the necessary action to complete all types of complex insurance billings and appeals. &nbsp;Reviews and analyzes the insurance processing procedures to identify potential problem areas and makes suggestions for more streamlined processing. &nbsp;Prepares reports as required and requested. &nbsp;Works with insurance payers on problem claims and processes. Resolves outstanding Accounts Receivable and credit balances as assigned.</p><p><span style=\"font-family: &quot;&quot;;\"><strong>Education</strong><i><strong>:</strong></i></span><span style=\"font-family: Calibri, sans-serif;\"><span style=\"font-size: 11pt;\">&nbsp;</span></span></p><p><span style=\"font-family: &quot;&quot;;\">High school diploma or equivalency required.&nbsp;</span></p><p><span style=\"font-family: &quot;&quot;;\">CPC, CCA, RHIA, RHIT certification in medical billing and coding or Associates degree preferred.</span></p><p><strong>Experience:&nbsp;</strong></p><p>Minimum 3 years experience in insurance billing or CPC certified. &nbsp;Must demonstrate current competencies applicable to the job and have proven experience in performing required tasks independently while contributing to the team environment. &nbsp;Must maintain a knowledge of medical terminology, CPT and IC</p><p>D‐10 Coding and insurance regulations. &nbsp;Strong organizational and customer service skills are a must. &nbsp;Previous experience in performing in a high volume and fast paced environment and demonstration of self‐motivation to develop and maintain the knowledge and skills for the position.</p><p><strong>Essential Functions:&nbsp;</strong></p><p>1. Identifies and evaluates denials for assigned payers and/or specialties to determine specific issues and patterns that need to be addressed. &nbsp;Serves on Denial Task Force(s) and assists in developing action plans to reduce denials and streamline clean claim submissions.</p><p>2. Exports data, prepares spreadsheets, creates and runs reports as needed to be used in the resolution of outstanding claims (ex. &nbsp;trending, projects, worklists) Identifies trends and provides appropriate follow‐up for claims that require correction/appeal.</p><p>3. Demonstrates skills and proficiency in analyzing complex billing problems, prepares appeals, challenges payer policies and pursues appeal turnover when necessary.</p><p>4. Works with team and department management to develop and train internal rejection protocols. &nbsp;Keeps current with coding knowledge, reimbursement policies, payer guidelines and other sources in order to ensure best practice procedures are followed.</p><p>5. Ensures staff adherence of protocols by audit and education.</p><p>6. Identifies and promptly reports payer, system or billing issues. &nbsp;Works with Applications Analyst, Supervisor, Manager and/or Director to provide recommendations and resolution.</p><p>7. Works with team and payers to ensure timely resolution of credit balances as assigned. &nbsp;Aids in the preparation of annual escheatment documentation.</p><p>8. Leads any payer specific external claim audit activity, worked in combination with Management, Compliance, Medical Records and Clinical Operations.</p><p>9. Serves as a group leader by performing one or more of the following duties: &nbsp;employee training, routing work assignment, participation in employment issues.</p><p>10. Reviews requested adjustments from Specialists, approving low dollar adjustments within policy guidelines. &nbsp;Gathers all information or documentation needed for Director approval of high dollar adjustments.</p><p>11. Performs testing and monitoring of new system logic or process with Business Analyst and/or Manager.</p><p><strong>Other Duties:&nbsp;</strong></p><p>1. Answers phone calls and correspondence providing requested information to aid in the resolution of account balances.</p><p>2. Maintains knowledge and performs within the compliance of Guthrie Medical Group and payer guidelines.</p><p>3. Provides feedback related to workflow processes in order to promote efficiency.</p><p>4. Utilizes Epic system functions accurately to perform assigned tasks. &nbsp;Example: &nbsp;Charge corrections, invoice inquiry, credits, charge review, claim edit, 277 rejections, etc. &nbsp; Trains staff on same as needed.</p><p>5. Demonstrates excellent customer service skills for both internal and external customers while promoting the same in the team environment.</p><p>6. Maintains strict confidentiality related to patient health information in accordance with HIPAA compliance.</p><p>7. Assists with and completes projects and other duties as assigned.</p><p><span style=\"font-size: 10px;\">#LI-MD1</span></p><p>&nbsp;</p>",
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