Insurance Specialist - Revenue Cycle

Job Description:

Only candidates who reside in the Louisville Metro area will be considered for this position.

ESSENTIAL JOB FUNCTIONS

Completes information on insurance forms.  Completes 1500 HCFA insurance for specifications required by insurance companies to allow for timely payment.   Maintains a workable knowledge regarding specifications in billing Medicare, Medicaid, Tricare and Commercial:  monitoring those accounts to meet specifications.   Monitors 1500 for demographic, CPT and charge accuracy.   Monitors current fee schedule and recommends as necessary, in compliance with state and federal law.   Assist insurance companies inquiring about accounts relative to insurance benefits deposition.  Demonstrates knowledge of the personal computer and applicable keystrokes in the electronic transmission of claims, including the correction of claims with minimal interruption.   Maintains a workable knowledge of the physician billing system.  Follows up on unpaid claims for both insurance and patients via phone, fax or mail, knowing when to become assertive.    Identifies overpayments on patient accounts and initiates refund and adjustment process in accordance with internal controls.  Answer phone and assists customers promptly and courteously who age through geriatric or who are emancipated minors.  Also assists physician offices promptly and courteously.   IP Maintains a working knowledge of PCN, retrieving information as needed for daily work disposition.  Maintains strict patient confidentiality.  Performs special assignments as required.  Able to demonstrate proper usage of office equipment.  Researches line item EOB’s for incorrect payment levels and works directly with insurance companies for assurance of benefits and correct reimbursement through oral and written communication. Monitors and maintains control for balancing purposes.     Monitors appropriate codes using the ICD-9 and the CPT formats.  Prints, reviews and mails all insurance claims as needed on a regular basis. Responds to and/or directs all correspondence.    Maintains direct line of communication with the providers and staff.  Communicates with the AR Manager regarding problem areas.    Maintains knowledge of Corporate Compliance issues pertaining to daily work.    Performs other duties as assigned.   

KNOWLEDGE AND ABILITIES

High school graduate or equivalent required.  Productive typing ability equivalent to 30 w.p.m. required. Considerable skill in interpersonal communications and the ability to work well with others as a team required.  Ability to keep accurate financial records and perform mathematical tasks required. Knowledge of medical terminology, ICD-10 and CPT coding required.  Knowledge of E/M procedural coding preferred. Computer knowledge required.  Knowledge of Windows preferred

EXPERIENCE

Minimum of two years of experience in a medical billing environment working with insurance and patient claims processing required.

PHYSICAL DEMANDS

Position has no unusual demands. Typical office job, requiring lifting of 10 pounds maximum, with occasional lifting and carrying of medical records.  Position may require walking or standing, stooping, or bending.  Minor discomfort from continual use of video display terminal.

Time Type:

Full time