Insurance Specialist - Vascular Surgery Associates - SCA Health
Tallahassee, FL 32308
About the Job
Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.
As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:
- We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
- We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
- We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
- We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.
The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.
Accountabilities / Responsibilities:
- Assures prompt, accurate credit balance research of patient accounts.
- Processes refunds and initiates insurance check refunds requests in Accounts Payable system.
- Sends overpayment letters series to carriers that have overpaid per contract.
- Reviews and validates written requests received from insurances.
- Submits payer disputes as needed.
- Answers calls and inquiries from third-party carriers in reference overpayments or refunds requests.
- Follows up on all outstanding credit accounts.
- Calculate and verify expected pay based on contractual allowances for multiple payers.
- Documents all work performed in patient accounting system.
- Review of patient account history and notes to determine next step required for resolution per company guidelines.
- Process contractual adjustment requests as needed to correct account balances.
- Promptly processes all government refunds within timelines.
- Runs monthly credit reports to verify that checks issued have been posted.
- Performs all other duties as assigned by supervisor.
- Excellent telephone skills & Customer Service Skills
- High level of self-organization and tracking
- Works independently, is a self-starter with a high level of initiative
- Strong communication skills, both verbally and in writing
- Possesses accurate judgement, especially handling insurance claims and dealing with patient accounts.
- Versatile and willing to coordinate with and participate in, when necessary, all other aspects of the Business Office.
- Ability to handle confidential information.
- Possess basic knowledge of medical terminology.
- Possess knowledge of health insurance billing.
- Read and interpret EOBs and can calculate expected allowances based on payer contracts to determine reason for balance.
- Possess knowledge of typing, word processing, spreadsheet and computer billing systems.
- Must be dependable and reliable.
- Ability to multi-task, think critically, and solve problems
- One or more years’ experience in a related position working in a medical office, hospital, outpatient surgery center or related field with core duties related to medical insurance collections, billing, accounts receivable, A/R, collecting payments, collecting re-imbursements, or related training/certificates/diplomas
