Senior Insurance Specialist - Marshall Medical Centers

• The following statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements, which may be inherent in the position.

• Position Summary: The Senior Insurance Follow Up Specialist performs job duties in accordance to established procedures, policies, and detailed instructions, drives resolution of unpaid claims and promotes top performance while delivering superior revenue cycle outcomes. This position interacts daily with team members, insurance representatives and other departments in an effort to quickly resolve outstanding account balances while enhancing the patient experience and ensuring integrity and compliance. This role serves as a subject matter expert.
• Primary Responsibilities:
• Works assigned claims to verify payment, reason for rejection, etc. and takes appropriate action to resolve claims and prepare for patient billing in a timely manner
• Exhibits strong communication skills and positive attitude with internal (team members, other departments, providers and leadership) and external customers (patients, insurance companies, vendors and employers).
• Follows workflow process to ensure correct registration, coding, payment/adjustment posting and insurance processing of claims.
• Conducts verbal and written inquiries to determine the reasons for unpaid/denied claims to reach resolution.
• Successfully manages claims in assigned worklists to meet/exceed productivity standards.
• Participates as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.
• Selects priorities and organizes work and time to meet them in order of importance.
• Recognizes and researches problematic trends regarding non-payment in an effort to implement preventive measures to increase cash collections.
• Provides documentation as requested by insurance companies and patients
• Utilizes payor websites and other software as required by assigned claims
• Assists patients as they call with questions regarding their statement or coverage
• Maintains requested statistics and reports
• Directs customer complaints to management for immediate response if unable to resolve.
• Actively participates in staff meetings and process improvement planning sessions.
• Understands HIPAA policies and procedures and uses this knowledge to practice in a manner that maintains the confidentiality of protected health information (PHI) in compliance with HIPAA.
• Performs other duties as assigned

Education/Licensure/Certification/Experience/Skills Requirements

Education:

• High School diploma or equivalent
• Years of experience: Minimum of 5 years in resolving insurance denials and/or revenue cycle

Skills:

• A basic understanding of insurance requirements and regulations, contract benefits, credit and collection procedures, financial assistance programs as well as a familiarity of medical terminology
• Advanced reading, writing and oral communication skills as well as the knowledge to perform mathematical calculations.
• Interpersonal skills necessary for making patient and third-party payer contacts.
• Must be able to work with interruption by co-workers or other internal customers needing assistance with patient accounts.
• Analytical and critical thinking ability to diagnose account issues and active listening skills to provide service excellence.
• Demonstrated project and time management skills and an ability to work effectively over the phone and in a team environment.
• Demonstrated proficiency in data entry and computers

PREFERRED QUALIFICATIONS:

• Knowledge of CPT and ICD terminology
• Familiarity with billing software
  

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