Insurance Specialist

Primary Objective  

The Insurance Specialist creates and sends medical claims for the insurance companies and the patients. The Insurance Specialist is responsible for reporting accurate information to the insurance company so the patient can be billed for the correct amount. Other responsibilities include following up on unpaid claims, clarifying discrepancies, reviewing bills, and confirming eligibility. 

Essential Functions  

• Review claims and correct any missing or inaccurate information 

• Verify coverage and eligibility for medical services 

• Communicate with insurance companies and occasionally patients 

• Use Epic to prepare claims 

• Collect unpaid claims and clear up discrepancies, including denials 

• Investigate and appeal claims that were denied 

• Ability to complete correspondence that is linked with OnBase and MediStreams, and respond to e-mails 

• Assist customer service, payment posters and managers regarding patient concerns and/or outstanding claims 

• Performs other duties assigned by management, including reports 

• Adapt to updates and changes in billing software 

• Ability to meet the physical and mental demands of the position 

• The ability to work on-site as needed 

• Predictable and reliable attendance 

Skills and Abilities  

• Proficient in Microsoft Excel 

• Proficient in Electronic Medical Record systems 

• Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS 

• Communication skills with healthcare companies 

• Ability to communicate professionally (written and verbal) 

Core Competencies 

• Attention to Detail 

• Effective Decision Making 

• Information Collection & Management 

• Multi-Tasking & Adaptability 

• Personal & Professional Ethics 

Clinical Competencies  

N/A 

Training Period 

90 days of on-site training is required prior to moving to remote work. 

Accountability 

Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A. 

Education 

High school diploma or GED 

Experience 

2 years’ experience working with revenue cycle process. Previous experience with Epic is a plus. Knowledge of medical terminology and ICD-10. Familiarity with basic computer operations. 

Certificates, Licenses, Registrations 

N/A 

Work Environment 

The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Work is remote, so employee should have discipline to work alone and have a dedicated workspace with highspeed internet which offers HIPAA compliance and room for two monitors.  

Equipment required to perform job duties include but are not limited to: High speed internet connection, laptop with two monitors, and a headset (will be provided), desk and chair (employee’s responsibility). 

Supervisory Responsibilities 

This position has no supervisory responsibilities. 

Position Type and Expected Hours of Work 

Full-time 40-hour weekly position. The hours may range between 7:00a.m. and 6:00p.m. 

Overtime may be required at certain periods. 

This is a telecommuting position, after the completion of the 90 day onsite probationary period and a complete understanding and demonstration of the outlined job duties. 

Physical, Mental and Other Requirements   

The physical and mental demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Physical Demands: Ability to sit in front of a computer for extended periods of time. Typing and repetitive clicking of a mouse. Ability to be able to set up laptop and monitors when working remotely.  

Mental Demands: Must have ability to problem solve. Ability to work under pressure. Ability to make quick decisions. Ability to interpret data. Ability to work alone for long periods of time.   

Other Requirements:   

• Active & Current Driver’s license   

• Clean driving record   

• Consistent and Reliable Transportation   

• Polite and professional disposition   

Travel 

Scheduled days onsite at the University office to be coordinated with Supervisor. Typically, 1 day every other week 

Other travel is not required for this position, except when training or occasional in-person staff meetings 

In the event the employee is experiencing technical difficulties at home (i.e., issues with the laptop, unable to connect to the VPN, internet issues), they will need to work at a CEENTA location. 

Other Duties 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice. 

A Typical Day in the Position 

The Insurance Specialist is responsible for the timely submission and follow-up on all pending insurance claims.  Typical responsibilities include but are not limited to: working assigned work queues in a timely and accurate manner, contacting payers for updates and or appeals, address emails/in-baskets in a timely manner, address voicemails, communicate as needed with providers and staff, update billing on accounts. Completing correspondence that is linked with OnBase and MediStreams, and respond to e-mails. The Insurance Specialist should become familiar with the payers that they deal with on a regular basis. The Insurance Specialist should be  able to work independently and solve routine type issues but when trends or potential systemic issues are noted, these should be reported to their immediate supervisor/manager for resolution and or escalation as needed. 

Equal Employment Opportunity Statement  
The Company bases all applicant and employee employment decisions without regard to race, creed, color, religion, age, gender identity or expression, sexual orientation, pregnancy, genetic information, national origin, sex, uniform service, veteran status, protected disability, and any other category protected under federal or state law. This policy of equal employment opportunity applies to all policies and procedures relating to employment including, but not limited to recruitment, placement, employee training and development, promotion, benefits, compensation, leaves of absence, position elimination, layoff, recall, termination, and all other terms and conditions of employment. The Company opposes racial injustice and racial inequality. We strive to provide a diverse workplace wherever employee’s background and experiences are important and bring value to us as an organization. Employees should bring any violations of this policy to the attention of Human Resources.  

 The South Carolina Pregnancy Accommodation Act protects individuals from employment discrimination for medical needs arising from pregnancy, childbirth or related medical conditions. The Act, which amended the South Carolina Human Affairs Law, also requires that employers provide reasonable accommodations for medical needs arising from pregnancy, childbirth or related medical conditions.  Should you have any questions, please contact Human Resources.  

 Accessibility Accommodation Statement Charlotte Eye, Ear, Nose and Throat Associates is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended (“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualified employee or applicant with regard to any terms or conditions of employment on the basis of such an individual’s disability. If you are an applicant and need a reasonable accommodation when applying for job opportunities within the Company or request a reasonable accommodation to utilize the Company’s online employment application, please contact hr@ceenta.com. 

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