Medical Insurance Specialist

4 weeks ago


Lake Forest, United States KIM TANG MD INC Full time
Job DescriptionJob Description

JOB TITLE: MEDICAL INSURANCE SPECIALIST

EMPLOYER: KIM TANG MD INC

DEPARTMENT: INSURANCE

REPORTS TO: INSURANCE BILLING DEPARTMENT MANAGER

EFFECTIVE DATE: 03/01/2024

SUMMARY: Under direct supervision of the billing department manager this position’s daily responsibilities include but are not limited to medical claim submissions, posting insurance EOBs, processing patient payments, working accounts receivable and obtaining medical authorizations. This position requires effective communication with physicians, patients, insurance carriers, and pharmacies.

DUTIES AND RESPONSIBILITIES:

  • Identify benefit coverage of HMO, PPO, primary, secondary or tertiary insurance coverage

  • Accurately enter insurance billing information

  • Submit requests for HMO authorizations

  • Submit medical claims to insurance companies

  • Post insurance and patient payments

  • Work accounts receivable aging – both insurance and patient accounts

  • Contact patients regarding past due account balances

  • Submit patient accounts to collections

SUPERVISORY RESPONSIBILITIES:

  • This job has no supervisory responsibilities.

QUALIFICATIONS:

  • Minimum 1-year medical insurance department experience required.

  • Basic knowledge of CPT and ICD 10 billing codes with regards to claim submission

  • Ability to interpret insurance explanation of benefits

  • Knowledge of HMO insurance requirements – Ability to review physician orders for medical necessity and accuracy to support authorization requests.

  • Professionally communicate with patients regarding insurance questions and account balances.

COMPETENCIES:

  • Diversity - Shows respect and sensitivity for cultural differences

  • Ethics - Treats people with respect; Works with integrity and ethically; Upholds organizational values.

  • Attendance/Punctuality



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