Insurance Specialist

1 month ago

Marietta, United States Pinnacle Orthopaedics Full time
Job DescriptionJob DescriptionDescription:

Job Summary: Insurance Specialist Under the direction of the Revenue Cycle Manager, the Insurance Specialist Duties and Responsibilities include the following. Work accounts in eClinicalWorks as assigned by Payor from the RCM. Post electronic remittance advice as required, work all incoming mail for your Insurance Carrier(s), responsible for follow up and appeal on all claims for your payor(s). Help cover peer’s calls in their absence along with any other duties that your manager assigns you.

Essential Duties:

  • Responsible for Insurance follow up and collections for the individual Insurance Payors you are assigned.
  • Post Electronic Remittance Advise as requested and appeal denied claims as necessary.
  • Follow up on outstanding claims to reduce days in AR.
  • Process incoming mail.
  • Closely monitor network bulletins for any changes that would affect this practice.
  • Must be willing to travel as needed to meet with Payors
  • Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
  • Perform other duties as assigned.
Requirements

Education:

  • High School Diploma or GED equivalent required.
  • Basic course in medical terminology, medical billing and/or accounting preferred.

Experience:

  • Prefer one to three years experience in medical billing and collections office.
  • Must possess strong understanding to the local managed care environment, including, but not limited to, managed care policies and procedures, reimbursement mechanisms, and practice management/medical office procedures.
  • Some coding experience preferred.
  • Management and organizational skills to support the leadership of this function.
  • Detail Oriented, professional attitude, reliable.
  • Ability to demonstrate effective customer service techniques.
  • Knowledge of insurance industry and basic medical terminology/abbreviations preferred.
  • Ability to use office equipment (copier, fax, pc etc.) and automated systems/applications/software at an acceptable level of proficiency including medical billing spreadsheets, email and word processing software.
  • Ability to establish and maintain effective working relationships with patients, staff and the public.
  • Ability to act independently and know when to refer situations to higher level authority or collaboratively as part of a team.
  • Ability to use discretion with confidential data and sensitive information.
  • eClinicalWorks and Waystar (Navicure) experience preferred.
Requirements:


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