Insurance Specialist (Denials Follow Up)

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

JOB SUMMARY: The Insurance Specialist is responsible for review and resolution of outstanding insurance balances on hospital or physician patient accounts. The Insurance Specialist will be required to have flexibility to learning and comprehending complex hospital systems and keen analytical skills to evaluate appropriate next steps to bring aged account receivables to resolution. The Insurance Specialist will be responsible to ensure cash recovery goals are met and assigned hospital receivables are appropriately addressed according to company, client, and federal guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

ESSENTIAL JOB FUNCTIONS:

Effectively manages assigned insurance receivables to achieve business line expectations                                  

• Meets productivity standards as outlined by business line
• Achieves a minimum of 85% work quality scoring and accuracy on all accounts worked
• Completes timely follow-up on assigned accounts to ensure no cash loss
• Meets monthly cash expectations as set out for assigned client receivables
• Ensures insurance accounts are resolved within 90 days of placement    
• Demonstrates the ability to prioritize work with some oversight to meet outlined goals

• Perform account research and route accounts through appropriate client workflows                                 
• Ability to understand, navigate and perform research of account within client host systems
• Exceptional understanding of patient accounting systems allowing for ease of transition and learning of new systems as needed by business line
• Clearly documents actions taken and next steps for account resolution in patient accounting system
• Excellent working knowledge of Prism system and displays clear understanding of claim updates, request workflow, and action step entry into the system
• Appropriately makes request for documentation based on account needs and compliance guidelines
• Ability to navigate billing system to perform basic claim billing functions
• Clearly prepares appeals for payment to insurance company when appropriate
• Ensure strong communication skills to convey intricate account information

• Ensure all accounts are worked within client standards and Federal Regulations.                         
• Maintain high quality account handling per client standards
• Work within federal, state regulations, department/division & all Compliance Policies       
• Maintain clear, concise, and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications                                     

• Maintain continuing education, training in industry career development                                                    
• Maintain current knowledge of and comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA, etc.
• Attend training sessions as directed by management
• Integrate information obtained through training sessions and policy changes immediately into daily routine

EDUCATION: High School or Equivalent

EXPERIENCE: 1 year experience in a health care receivables environment.

*Must have experience in MediTech*

MUST HAVE:

• Excellent oral and written communication skills
• Basic computer skills
• Familiar with widely used patient accounting software

OTHER HELPFUL EDUCATION OR EXPERIENCE

• Organization, planning and prioritizing
• Communication skills
• Data management
• Attention to detail and accuracy
• Problem-solving
• Adaptability and flexibility

KNOWLEDGE, SKILLS and ABILITIES

• Possess excellent reading and writing skills
• Strong Computer skills
• Communicate successfully with patients, hospitals, insurance companies and CorroHealth Employees
• Work individually and as part of a team
• Possess ability to concentrate for long periods of time
• Proficient in numeracy skills
• Pays close attention to detail
• Must possess excellent grammar and spelling skills
• Proficient in knowledge and use of email and internet
• Possess above average knowledge of administrative procedures

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.