Medical Insurance Specialist
1 week ago
Medical Insurance Specialist - Remote in Utah or North Carolina ONLY
About the Job:Job Title: Medical Insurance Specialist Company: The Orthopedic Partners Location: Utah or North Carolina RemoteStart Date: February 2024Classification: This is a full-time, non-exempt position with benefits. If you're interested in part-time, please apply, we're open to discussing alternative schedules. Description:As a Medical Insurance Specialist in an Orthopedic Office, your primary responsibility is to assist the Revenue Cycle Director in supporting the revenue cycle team as they navigate the complex insurance landscape and ensure accurate billing and reimbursement for orthopedic services. You will work closely with patients, healthcare providers, insurance companies, and other stakeholders to verify insurance coverage, obtain authorizations, submit claims, and resolve billing-related issues. Your knowledge of insurance processes, attention to detail, and effective communication skills will contribute to the financial success and compliance of the orthopedic office. Primary Responsibilities:Insurance Verification:
- Verify patient insurance coverage, benefits, and eligibility for orthopedic services.
- Collect and update patient insurance information accurately in the electronic health record (EHR) system.
- Communicate with insurance companies to obtain detailed information about coverage limitations, preauthorization requirements, and billing guidelines.
Claims Submission and Billing:
- Accurately prepare and submit insurance claims for orthopedic services using appropriate coding systems (ICD-10-CM, CPT, and HCPCS).
- Ensure claims are complete, accurate, and comply with insurance company guidelines and requirements.
- Monitor and track claim statuses, following up on outstanding or denied claims, and take necessary actions to resolve issues.
Billing and Reimbursement:
- Review insurance payments and Explanation of Benefits (EOBs) for accuracy and adherence to contracted rates.
- Identify billing discrepancies, denials, or underpayments and initiate appropriate actions, including appeals, resubmissions, or adjustments.
- Identify overpayments and request offsets or refunds as appropriate.
- Collaborate with the billing team to resolve billing-related issues, answer insurance-related inquiries, and provide necessary documentation for appeals.
- Educate patients on insurance coverage, benefits, and financial responsibilities related to orthopedic services.
- Assist patients with understanding their insurance claims, EOBs, and billing statements.
- Provide financial counseling and assist patients in setting up payment plans or exploring financial assistance options when needed.
- Ensure compliance with coding and billing regulations, including HIPAA and other industry guidelines.
- Maintain accurate and up-to-date documentation of insurance-related activities, including authorizations, claims, appeals, and communication with insurance companies.
- High school diploma or equivalent (additional education or certification in medical billing, coding, or healthcare administration is a plus).
- Proven experience in medical insurance verification, billing, or similar roles in a healthcare setting, preferably in an orthopedic office.
- In-depth knowledge of medical insurance processes, including verification, preauthorization, claims submission, and reimbursement.
- Familiarity with orthopedic procedures, terminology, and coding systems (ICD-10-CM, CPT, and HCPCS).
- Strong understanding of insurance guidelines, regulations, and billing requirements.
- Proficiency in using computer systems and software for insurance verification, claims submission, and electronic health records.
- Excellent communication skills, both verbal and written, to interact effectively with patients, healthcare providers, insurance companies, and other stakeholders.
- Strong attention to detail and accuracy in data entry, documentation, and claims processing.
- Ability to handle confidential and sensitive information with discretion.
- Strong problem-solving and analytical skills to identify and resolve billing-related issues.
- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
- Knowledge of medical terminology, anatomy, and orthopedic-specific procedures is desirable.
- We offer competitive compensation and benefits packages.
- Health Insurance (Medical, Dental, Vision)
- Company 401k contribution
- Paid Time Off
- Paid Holidays
- Life Insurance
- Short- and Long-Term Disability Insurance
Note: This job description is intended to outline the general nature and level of work being performed by employees in this role. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required.
We are an Equal Opportunity Employer. We are committed to equal treatment of all employees without regard to race, national origin, religion, gender, age, sexual orientation, veteran status, physical or mental disability or other basis protected by law.
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